异丙酚在老龄患者球后神经阻滞中的应用

Clinical Study on Propofol Application to Elderly Patientsin Retrobulbar Nerve Block

目的探讨高龄眼科患者球后神经阻滞前应用异丙酚对其血流动力学的影响.方法将年龄≥65岁,ASA分级Ⅱ～Ⅲ级,择期行眼科手术的患者(40例)随机分为2组:A组为对照组,B组为异丙酚组,每组各20例.A组常规球后神经阻滞下手术,未用全麻药;B组静脉推注异丙酚0.4 mg/kg,1 min后行球后神经阻滞.围手术期观察2组患者的心率、血压、外周脉搏血氧饱和度(SpO2)的变化.结果 A组患者在阻滞后1 min时,收缩压、舒张压及心率与阻滞前相比明显升高(P<0.05),2～5 min后才逐渐恢复至术前水平.B组患者各时刻收缩压、舒张压及心率与阻滞前相比均无明显变化.B组患者球后神经阻滞后1 min,收缩压、舒张压较A组降低,心率较A组减慢,2组比较差异有统计学意义(P<0.05),2～5 min后逐渐恢复.结论老年患者在行球后神经阻滞时,静脉应用异丙酚0.4 mg/kg行清醒镇静,具有起效快、镇静效果好、血流动力学稳定、对呼吸影响小等优点.

Objective To investigate hemodynamics of elderly patients with propofol application before retrobulbar nerve block in department of ophthalmology. Methods There were 40 patients in department of ophthalmology to be operated, age≥65 years, ASA Ⅱ～Ⅲ grade. They were randomly allocated into A and B two groups. A was control group(n=20), B was propofol group(n=20). The patients of A group were routinely operated with retrobulbar nerve block without general anaesthetic. The patients of B group were injected propofol (0.4 mg/kg). Heart rate, blood pressure and SpO_2 of patients were in two groups in peri-operational period. Results Heart rate, systolic pressure and diastolic pressure increased significantly observed in patients of A group 1 minute after nerve block(P<0.05). They gradually returned to basic level after 2～5 min. Heart rate, systolic pressure and diastolic pressure did not change much in patients of B group every time points. There are significantly statistical difference between patients of A group and patients of B group in heart rate, systolic pressure and diastolic pressure 1 min after nerve block( P< 0.05). Conclusion Injecting propofol(0.4 mg/kg) into retrobulbar nerve block for elderly patients is advantageous in terms of qick effect, well sedation, stable hemodynamics, and less respiration disturbance.