老年高血压患者上腹部手术的麻醉探讨

Exploration of anesthesia at upper abdominal operation in old patient with hypertension

目的：探讨老年高血压患者上腹部手术的麻醉方法。方法：择期行胃癌根治术老年患者30例,术前合并1～2级高血压,30例均按WHO标准诊断,随机分成两组,每组15例：A组（单纯全麻）、B组（硬膜外复合全麻）。术中连续监测Bp、HR、SpO2、心率;记录术中知晓、术后躁动及麻醉药用量。结果：插管及拔管时,A组SBP、MAP、HR、RPP均明显高于麻醉前值（P〈0.01）,术后60及90minSBP、MAP、HR显著升高;同期B组无明显波动,组间比较差异有统计学意义（P〈0.01）;术毕至清醒时间A组（35.0±15.2）min,B组（10.0±4.6）min,组间比较差异有统计学意义（P〈0.01）。结论：静脉全麻复合硬膜外阻滞麻醉方法用于老年高血压病人上腹部手术,血流动力学波动小,全麻药量和术后躁动减少,病人恢复快。

Objective To discuss the anesthesia method at the upper abdominal operation in the old patient with hypertension.Method 30 old patients underwent selective radical operation of gastric cancer,with hypertension of grade 1～2 before surgery.The cases were divided into two groups randomly,and group A（n=15） with complete anesthesia,group B（n=15） with epidural anesthesia.Bp,HR and SpO2 during the operation,restlessness after the operation,and the dose of anesthesia drug were detected.Results Outstanding increase in SBp,MAP,HR and RPP was found in group A compared with preoperation when take off the anesthesia,and SBp,MAP,HR increased obviously 60 minutes and 90 min,utes after the operation,also had significant difference with group B（P〈0.01）.The awaken time in group A and group B was（35.0±15.2） min and（10.0±4.6） min,respectively,and with significant difference（P〈0.01）.Conclusion Complete anesthesia plus epidural anesthesia at upper abdominal operation in old patient with hypertension can decrease the haemodynamics fluctuation,diminish the dose of anesthesia drug and restlessness after the operation,and get recovery quickly.