老年患者硬膜外麻醉诱导期间乳酸钠林格氏液的液体动力学研究

Induction of epidural anesthesia in elderly patients with lactated Ringer's solution during the study of liquid dynamics

目的探讨老年患者适宜的临床液体治疗方案。方法硬膜外麻醉下行下肢或盆腔手术的老年患者30例(年龄≥65岁),随机分为3组,每组10例。A组60min内持续输注复方乳酸钠10ml/kg,B组60min内持续输注复方乳酸钠15ml/kg,C组60min内持续输注复方乳酸钠20ml/kg。所有患者输液20min开始硬膜外给药,麻醉平面上界控制在T10～T12,研究结束后方可手术。记录输液前及输液60min内每隔5分钟的心率及收缩压、舒张压、中心静脉压(CVP)及血红蛋白(Hb)浓度的数值。结果3组患者在输注复方乳酸钠后血液稀释度均有所变化(P<0.05)。与A组相比,C组T45后的血液稀释度变化有显著性差异(P<0.05)。CVP较基础值升高,有显著性差异(P<0.05)。结论B组的输液方案比较适宜,能更好地预防老年患者硬膜外麻醉诱导期间低血压。

Objective To study in elderly patients with appropriate clinical liquid treatment. Methods 30 cases of epidural anesthesia in the lower extremity or pelvic surgery in elderly patients （≥65 years）,were randomly divided into 3 groups of 10 cases. A group of 60 min continuous infusion of compound sodium lactate with 10ml/kg,B group with 60 min continuous infusion of compound sodium lactate 15ml/kg,C group 60 min continuous infusion of compound sodium lactate with 20ml/kg. All patients with epidural administration began 20min infusion,narcotic control plane sector T10-T12, end of the study before surgery. Record before infusion and infusion every 60 min within 5 minutes of heart rate and systolic blood pressure,diastolic pressure,central venous pressure （CVP） and hemoglobin （Hb） concentration values. Results 3 group patients in the blood after infusion of compound sodium lactate have all been changed dilution （P〈0.05）. Compared with the A group,C group after T45 dilution of the blood changes were significantly different （P〈0.05）. Higher than the basic value of CVP,the difference was significant （P〈0.05）. Conclusion Group B infusion is more appropriate program,to better prevention in elderly patients with hypotension during epidural anesthesia.