42例合并心肌缺血的老年肿瘤病人围麻醉期管理

The perianesthesive period management of 42 elder tumor patients with myocardial ischaemia

目的：探讨合并心肌缺血的老年肿瘤病人围麻醉期管理。方法：42例合并心肌缺血老年的肿瘤病人进行全麻手术,采用异丙酚、瑞芬太尼静脉全身麻醉,根据心电图、血压、心率、脉搏、氧饱和度等监测结果,给予硝酸甘油、倍他乐克或艾司洛尔、利多卡因等处理,以维持血流动力学稳定。结果：37例患者停药后10-15min清醒,呼吸功能和肌张力恢复,5例患者15-20min清醒,恢复呼吸功能和肌张力。全部病例围麻醉期心血管或血流动力学指标平稳,无1例发生心衰、心肌梗塞、严重心律失常和麻醉意外等并发症,术后恢复良好。结论：采用异丙酚、瑞芬太尼静脉全身麻醉并维持一定深度麻醉,充分供氧,加强术中监测,适当酌情使用硝酸甘油、倍他乐克或艾司洛尔等,维持心血管系统和血流动力学稳定,对合并心肌缺血的老年肿瘤病人顺利度过手术麻醉期有重要的作用和临床意义,也是围麻醉期管理的关键。

Objective： To investigate the perianesthesive period management of elder tumor patients with myocardial ischaemia. Methods： Forty two elder tumor patients with myocardial ischaemia were proceeded surgical operation with general anaesthesia using propofol and remifentanil. Given nitroglycerin, betaloc or esmolol hydrochloride, lido- caine etc by the result of the electrocardiogram, blood pressure, heart rate, pulse, saturated degree in oxygen etc. to maintain the stability of hemodynamics. Results： Thirty seven patients wake up in 10 - 15 min after stopping the medicine, the breath and the muscle tension resume; 5 patients wake up in 15 - 20 min after stopping the medicine, the breath and the muscle tension resume. All patients heart - blood - vessel and hemodynamics index sign were steady. No one had heart failure, cardiac infarction, terrible heart rate disorders and anaesthesia accident, everyone recovered well after operation. Conclusion： Anesthetized with propofol and remifentanil and keep a certain degree, provide enough oxygen, enhance monitor in the surgical operation, give nitroglycerin, betaloc or esmolol hydrochloride properly, maintain the stability of hemodynamics has a great meaning to the elder tumor patients with myocardial ischaemia.