Bioz无创监测系统评价氢吗啡酮对老年高血压患者全麻术后血流动力学的影响

Effect of hydromorphone on hemodynamics after general anesthesia in elderly patients with hypertension under evaluation of Bioz noninvasive monitoring system

目的探讨Bioz无创血流动力学监测系统评价氢吗啡酮对老年高血压患者全麻术后血流动力学的影响。方法60例行择期全麻腹部手术的老年高血压患者为氢吗啡酮组(HM组)和生理盐水组(SP组)。手术结束前15 min,HM组皮下注射氢吗啡酮,SP组皮下注射生理盐水。观察2组患者在麻醉诱导前(T1)、拔管时(T2)、拔管后10 min(T3)的心率(HR)、平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)、外周血管阻力(SVR)。记录2组患者自主呼吸恢复时间、唤醒时间、拔管时间和转出PACU时间。记录患者进入PACU后5 min(H1)、15 min(H2)、30 min(H3)的视觉模拟评分(VAS)评分、Ramsay镇静评分。结果与HM组相比,SP组患者HR、MAP、SVR、VAS评分、Ramsay评分显著增高(P<0.05);与T1时相比,2组T2时HR、MAP、SVR显著升高,CO、CI显著降低(P<0.05);2组T3时SVR较T2降低,但显著高于T1(P<0.05)。HM组H2、H3时刻VAS评分、Ramsay评分显著升高(P<0.05)。2组患者自主呼吸恢复时间、唤醒时间、清醒拔管时间无显著差异(P>0.05)。结论 Bioz无创血流动力学监测系统能够提供全面有效的血流动力学信息,术毕前皮下注射氢吗啡酮1 mg可有效维持老年高血压患者全麻恢复期血流动力学的稳定。

Objective To explore the effect of hydromorphone on hemodynamics after general anesthesia in elderly patients with hypertension under evaluation of Bioz noninvasive monitoring system. Methods Sixty elderly hypertension patients with selective abdominal operation under general anesthesia were randomly divided into hydromorphone group（ HM group） and normal saline group（ SP group）,and 15 min before the end of surgery,hydromorphone was injected in the MH group,while the normal saline was injected in the control group. The indicators such as heart rate（ HR）,mean arterial pressure（ MAP）,cardiac output（ CO）,cardiac output index（ CI） and systemic vascular resistance（ SVR） were measured at different time points of before induction of anesthesia（ T1）,extubation（ T2） and 10 min after extubation（ T3）. Recovery time of spontaneous breathing,awaking time,extubation time and out of PACU time were recorded. The visual analogue score（ VAS）,Ramsay sedation score at the PACU were also recorded at 5 min（ H1）,15 min（ H2） and 30 min（ H3）.Results Compared with HM group,HR,MAP,SVR,VAS and Ramsay score increased significantly in the SP group（ P〈0. 05）. Compared with the indexes at T1,HR,MAP,SVR increased significantly while CO,CI decreased significantly at T2（ P〈0. 05）. In both groups,SVR at T3 decreased but was significantly higher than that at T1（ P〈0. 0 5）. compared between two groups at H1timepoint in PACU,VAS and Ramsay score in group SP at H2,H3 time point were no different（ P〈0. 05）. VAS and Ramsay scores in HM group at H2,H3 were increased significantly（ P〈0. 05）. There were no significant differences in the recovery time of spontaneous breathing,awaking time and extubation time between two groups（ P〈0. 05）. Conclusion Bioz non-invasive hemodynamic monitoring system can provide effective hemodynamic information,and subcutaneous injection of 1 mg hydromorphone before the end of operation can effectively maintain the hemodynamic stability during the recovery period of general anesthesia in elderly patients with hypertension.