不同麻醉方式对老年冠心病患者围术期血流动力学及ECG的影响

Effects of different anesthesia methods on perioperative hemodynamics and ECG in old CHD patients

目的:探讨对择期腹部手术的老年冠心病患者心脏血流动力学及心脏电活动影响较小的麻醉方式。方法:133例择期腹腔手术的老年冠心病患者随机分为硬膜外麻醉组(EA),全麻组(GA)和腰-硬联合麻醉组(CSEA)。术中连续监测,分时段记录平均动脉压(MAP)、心率(HR)、血氧饱和度(SaO2)及异常心电图,比较3组组间及组内差异。结果:麻醉后15 min和麻醉后30 min,GA组的SaO2明显高于EA组(P<0.05)。麻醉后15min、30 min和60 min CSEA组MAP值比EA组明显升高(P<0.05);麻醉后30 min,CSEA组的HR比EA组明显升高(P<0.05);麻醉后15 min和30 min,CSEA组的SaO2比EA组明显升高(P<0.05)。组内比较,EA组麻醉后15min、30 min、60 min,MAP、HR、SaO2三个指标均比麻醉前明显降低(P<0.05),GA组和CSEA组前后比较差异不明显(P>0.05)。异常ECG,组间比较,GA组和CSEA组ST-T改变发生率在麻醉后15 min、30 min、60 min、术毕时均明显低于EA组(P<0.05,P<0.01),GA组和CSEA组心律失常发生率在麻醉后15 min、30 min、60 min均明显低于EA组(P<0.05,P<0.01);组内比较,GA组和CSEA组的ST-T改变和心律失常发生率在麻醉后15 min、30min、60 min、术毕时均明显低于麻醉前(P<0.05,P<0.01)。结论:老年冠心病患者腹腔手术时全麻和腰-硬联合麻醉术中血流动力学较稳定,心电异常发生率较小。

Objective： To explore an optimal anesthesia method with less impact on hemodynamics and electrocardiogram（ ECG） of old patients with coronary artery disease（ CHD） during abdominal operation. Methods： The 133 CHD patients waiting for abdominal operation were randomly divided into continuous epidural anesthesia （EA）group, general anesthesia group（GA） and combined spinal-epidural anesthesia （CSEA） group. Continuous monitoring was carried out during operation and mean arterial pressure （MAP）, heart rate （HR）, oxygen saturation （SaO2）, abnormal ECG were measured respectively at different time for comparison and the differences of the above hemodynamic parameters and abnormal ECG features were compared among the 3 groups. Results： At the 15 min and 30 min point after anesthesia, SaO2 in GA group was significantly increased compared to that in the EA group（ P 〈0.05）. At 15 min, 30 min and 60 min point after anesthesia, MAP in CSEA group was significantly increased compared to that in the EA group（ P 〈0.05）. At 30 min point after anesthesia, HR in CSEA group was increased significantly compared to the EA group（ P 〈0.05）. At 15 min and 30 min point after anesthesia, SaO2 in the CSEA group was increased significantly compare to the EA group（ P 〈0.05）. Compared with preanesthesia （To） in EA group, MAP, HR and SaO2 decreased significantly at 15, 30 and 60 min after anesthesia（ P 〈 0.05）. The fluctuation of the three parameters in GA and CSEA groups were relatively small（ P 〉 0.05）. As well as the comparison of abnormal ECG among the 3 groups was concerned, the incidence of ST-T changes in GA and CSEA groups were significantly lower than that in EA group at the time of 15 min, 30 min and 60 min after anesthesia and at the time of surgery termination（ P 〈 0.05, P 〈 0.01）. The incidence of arrhythnfia in GA and CSEA groups were significantly lower than that in EA group at the time of 15 min, 30 min and 60 min after anesthesia（ P 〈 0.05, P 〈 0.01 ）. Compared with TO in the same group, the incidences of ST- T changes and an＇hythmia in GA or CSEA group at the time of 15, 30 and 60 min after anesthesia and at the time of surgery termination were significantly lower than that before anesthesia（ P 〈 0.05, P 〈 0.01）. Conclusion： GA and CSEA have less impact on hemodynamics and have smaller incidence of abnormal ECG of old CHD patients with abdominal operation.