老年直肠癌患者静脉麻醉期血液粘度变化的临床观察

Blood viscosity in elderly patients with colorectal cancer during venous anesthesia

目的观察老年直肠癌患者在丙泊酚静脉麻醉下的血液粘度变化。方法选择拟在全身麻醉下实施择期直肠癌根治手术,ASA Ⅰ~Ⅱ级,无合并高血压、冠心病、糖尿病等影响血液粘度疾病的老年患者25例。所有患者均采用丙泊酚静脉麻醉,分别在麻醉输液前（T0）、麻醉诱导插管后,BIS达到40-60并维持1 h（T1）、手术结束前10 min（T2）、术毕拔管患者入PACU后30 min（T3）四个时点经肘静脉各采血5 ml,检测高切全血粘度（Hηb）、中切全血粘度（Mηb）、低切全血粘度（Lηb）、血浆粘度（ηP）。结果全血粘度指标（Hηb、Mηb、Lηb）变化趋势基本相同：与T0比较,T1指标显著降低（P〈0.05）,至T2继续降低（P〈0.05）,T3开始升高,但仍较T0低（P〈0.05）。ηp在T1较T0显著升高（P〈0.05）。结论老年直肠癌患者血液粘度经历了麻醉中降低,术后早期开始升高的变化过程。

Objective To observe the changes of blood viscosity during anesthesia in elderly patients with colorectal cancer.Methods25 patients（age ≥65 years old,n=25,ASA I-Ⅱ） scheduled for elective radical surgery for colorectal cancer under general anesthesia,without diseases affecting the blood viscosity such as hypertension,coronary heart disease and diabetes were enrolled.All patients received the same propofol venous anesthesia.Blood samples were taken at 4 different time points,T0,prior to the infusion and induction of anesthesia;T1,anesthesia reaching a steady state（BIS 40-60 and maintained 1 hour） after intubations;T2,10min before the end of operation;T3,into the PACU 30 minutes.5ml bloods were taken from elbow vein used for the hemorheological measurements within 4 hours.Blood viscosity was determined with the automatic reological examining machine.ResultsCompared with T0,all whole blood viscosity（Hηb,Mηb and Lηb） significantly declined at T1（P〈0.05）,and continued decrease at T2（P〈0.05）.At T3,these parameters began to ascend,but still lower than T0（P〈0.05）.In particular,T1 of ηP was markedly higher than T0（P〈0.05）.ConclusionsThe blood viscosity decreased significantly in elderly patients after propofol intravenous anesthesia,but increased in early stage in postoperative period.