106例心动过缓高龄病人的麻醉处理

The anesthetic management in elderly patients with bradycardia.

目的 报告 10 6例心动过缓的高龄病人的麻醉处理。方法 根据心血管系统异常程度 ,有 2 0例麻醉前放置临时起搏器 ,选用全麻 ;其余 86例未放置起搏器 ,选择硬膜外加全麻。测定诱导后 10分钟、切皮时、拔管时BP、HR、SpO2 以及围手术期心电图的变化。结果 诱导后 10分钟BP均下降明显。未安起搏器 86例患者中 ,有 2 6例心率低于 6 0次 /分 ,需要给阿托品提高心率 ,其中 5例给阿托品 2mg无效 ,改给麻黄素后心率上升 >6 0次 /分 ,1例心率 <5 0次 /分 ,给阿托品、麻黄素无效 ,停手术 ,次日放置临时起搏器后顺利完成手术。拔管时患者BP、HR无明显变化。结论 老年心动过缓的手术患者 ,术前可视病情安置临时起搏器 ,并选用全麻或硬膜外加全麻 ,对循环功能影响小 ,有利于术后镇痛 。

Objective To report the managemnt in 106 cases of elderly patients with bradycardia. Methods Patients with (n=20) or without (n=86) temporary pacemakers before operation were scheduled for surgery under general or general combined with epidural anesthesia. BP, HR and SPO 2 as well as the ECG change during perioperative period were measured 10 minutes after induction, at the time of incision, and extubation. Results BP had a significant decrease 10 minutes after induction in all patients. In 86 patients without pacemakers, 26 cases had been observed bradycardia (HR<60bpm). The patients received atropine in order to increase their HR, 5 cases were changed to ephedine after 2 mg atropine were given. Both atropine and ephedine were found invalid in one case, this patient was inserted a temporary pacemaker the next day and operation was completed. No significant difference was obtained in BP and HR at the time of extubation. Conclusions The temporary pacemakers should be implanted in aged patients with bradycardia before surgery.