老年患者全麻联合硬膜外阻滞下中上腹部手术期间血液动力学变化及缺血性心肌改善的观察

The observation of hemodynamics and ST segment changes during middle-up abdominal surgery under general anesthesia combined with thoracice pidural block in elder patients

目的观察老年患者全麻联合硬膜外阻滞下中上腹部手术期间血液动力血改变及缺血性心肌改善。方法择期中上腹部手术老年患者35例，年龄70～85岁，平均（76±5）岁，ASAⅠ-Ⅲ级，监测HR、NIBP、ECG、SPO2，Flotrac传感器至Vigileo监测仪上得到血流动力学的监测指标，心排指数（CI）、每搏量变异度（SVV）、外周血管阻力（SVR）等血液动力学指标，并连接至OhmedaS／5型监护仪得到动脉压力波直接得到有创动脉（IBP）以及心电图ST段改变分析；并记录在麻醉前，胸段硬膜外阻滞后15min，全麻诱导后插管时，切皮时，探查时，术毕，拔管后等各时期的指标。结果麻醉前，全麻诱导时，切皮时，探查时，术毕时，IBP，CVP，SVR显著下降（P〈0．01）；在硬膜外阻滞后以及全麻诱导时ST段压低改善（P〈0．01）；胸段硬膜外阻滞后，全麻诱导时，CI降低（P〈0．01），在术毕和拔管时可恢复至麻醉前的水平（P〉0．05）。总结胸段硬膜外阻滞可以改善心肌缺血，心指数在硬膜外阻滞后，全麻诱导，然后加深时逐渐恢复，至拔管时可以恢复至麻醉前的水平。全麻联合硬膜外阻滞下行中上腹部手术对老年人缺血性心肌改善是有益处的。

Objective To observe the change of hemodynamics and ST segment in elderly patients during middle-up abdominal surgery under general anesthesia combined with thoracic epidural block. Methods 35 elderly patients scheduled for middle-up abdominal surgery were studied. The changes of their hemodynamic parameters from Flotrac/Vigileosystem （Edwards Lifesciences, USA） such as cardiac index （CI）, stroke volume variations （SVV）, systemic vascular resistance （SVR）, center venous pressure （CVP）, heart rate （HR）, invasive blood pressure （IBP） and ST segment changes were recorded before anesthesia, induction, incision, exploration, finishing of operation, after extubation. Results The IBP, CVP, SVR were lower than that at the point of before anesthesia, induction, incision （P〈0.01）; ST segment depression was ameliorated after thoracic epidural block, induction （P〈 0.01）. CI decreased after thoracic epidural block, at induction （ P 〈 0.01 ）, recovered to the level of that before anesthesia at finishing of operation, and extubation （P 〉 0.05）. Conclusions Thoracic epidural block could ameliorated myocardialischemia. CI could decrease after thoracic epidural block, induction and even recovered to the level of that before anesthesia after extubation. General anesthesia combined with thoracic epidural block could be beneficial for middle-up operation in the aged.