硬膜外阻滞复合浅全麻用于老年高血压病患者开胸手术(1)
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【摘要】 目的 观察硬膜外阻滞复合浅全麻对老年高血压患者开胸手术血流动力学变化、术中知晓及苏醒时间的影响。方法 择期开胸手术的老年高血压患者60例,随机分为单纯全麻组(Ⅰ组)和浅全麻复合硬膜外阻滞组(Ⅱ组),监测两组患者术中的血流动力学变化和ECG的变化及全麻药用量和苏醒时间。结果 Ⅰ组出现明显的心血管反应,尤以插管及拔管时显著高于基础值(P<0.05),Ⅱ组各时点血流动力学稳定,与Ⅰ组比较有显著差异(P<0.05),心肌缺血有所改善,全麻药用量明显少于Ⅰ组(P<0.01),术后清醒及气管拔管时间与Ⅰ组比较明显缩短(P<0.01)。结论 硬膜外阻滞复合浅全麻可减轻应激反应,循环状态稳定,全麻用药量减少,苏醒快,是老年高血压患者开胸手术的首选麻醉方法。
【关键词】 浅全麻;硬膜外阻滞;老年;高血压;血流动力学
Application of epidural analgesia compounds light general anesthesia in thoracic surgery of senile hypertension patient
WU Man,XING Gui-ying,YU Jian-she,et al.
Department of Anesthesiology,Affiliated Hospital,Inner Mongolia Medical College,Huhhot 010050,China
【Abstract】 Objective To study the influenence of epidural analgesia compounds light general anesthesia on hemodynamic, intraoperative awareness and the revival time in thoracic surgery of senile hypertension patients.Methods SixtyASAⅠ～Ⅱpatients undergoing elective thoracic surgery,were randomly assigned to be operated upon general anesthesia (groupⅠ,n=30) and combined light general anesthesia and thoracic epidural anesthesia (groupⅡ,n=30).The hemodynamic changes,ECG,dosage of anesthetic and revival time were observed during operation.Results The singnificant cardiovascular reaction were observed In group Ⅰ,especially after intubation and before extubation (P<0.05),In groupⅡ,BP and HR were more stable during perioperation compared with group Ⅰ(P<0.05). myocardiac ischemia was improved,the dosage of anesthetic in group Ⅱ was less than that in group Ⅰ(P<0.01); The revival time and the tracheal extubation time in groupⅡ was shorter than the group Ⅰ(P<0.01).Conclusion Epidural analgesia compounds light general anesthesia can stabilize the hemodynamics and reduce the stress respones.It is the first choice for pulmonary surgery of senile hypertension patients.
【Key words】 Light general anesthesia;Epidural block;Senile;Hypertension;Hemodynamics
DOI:10.3760/cma.j.issn 1673-8799.2010.11.12
作者单位:010050内蒙古医学院附属医院麻醉科
老年高血压病患者各系统脏器功能减退,对麻醉手术耐受力降低,围手术期风险大,选择适宜的麻醉方法达到最佳麻醉效果,减少用药量,保持平稳的血流动力学,有效抑制不良刺激反应,是老年高血压患者麻醉手术安全的重要保证 ......
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