老年喉癌患者围手术期的心电图异常改变

Abnormal changes of electrocardiogram in elderly patients with laryngocarcinoma during operation

目的:探讨老年喉癌患者围手术期间心电图异常改变的原因、机理及其预防和处理.方法:89例喉癌手术患者按年龄分为2组,65～80岁45例为观察组(A组),65岁以下44例为对照组(B组),患者均在局麻下行气管切开插管,静吸复合维持麻醉.常规监测EKG,SBP,DBP,HR,RR,SpO2、PETC02.结果:A组45例中17例(37%)、B组44例中2例(4.5%)在分离喉周围组织、切喉时出现异常心电图改变,包括ST-T改变、窦性心动过缓、结性心律、频发房早及室性早搏,并伴有不同程度血压下降,两组患者发病率差异统计学意义(P＜0.01).结论:术前伴心、肺功能不全的老年患者在浅麻醉状态下行喉癌手术、胆道手术、眼球手术同样会发生迷走心脏反射.

Objective： To study the reasons, mechanism, prophylactic and management of abnormal changes of electrocardiogram in elderly patients with larngocarcinoma during operation. Methods： Fourty - five patients above 65 years（group A） and 44 patients below 65 （group B） were investigated. All the patients were intubated by tracheotomy with local anesthesia to maintain anesthesia with intravenous balanced inspirative enflurane. EKG, SBP, DBP, HR, RR, SPO2 and PETCO2 were monitored. Results： Abnormal changes including ST - T change, sinusbradycardia, nodal rhythm,ventricular premature beats with different degree of hypotention were observed during disposal of the tissues around the larynx in 17 patients in group A （37.0 % ） and 2 in group B （4.5 % ）. Statistically difference in incidence rate between the two groups was observed （P 〈 0.01 ）. Conclusion： Vagocardiac reflex may occur cduring laryngectomy, biliary tract surgery and oculor operation in some elder patients with cardiopulmonary insufficient before operation, especially in light anesthesia state.