初入高原患者手术麻醉对血流动力学的影响

Effects of surgical anesthesia on hemodynamics in newly-arrived patients in plateau area

目的研究初次进入高原的患者手术麻醉对其血流动力学的影响,探讨此类手术患者的麻醉处理方法。方法初入高原手术的患者100例,第1次来高原1周内为A组(n=30)、2周内为B组(n=35)、3周内C组(n=23)、4周内为D组(n=12),观察患者麻醉前、麻醉中、术后24 h后麻醉恢复期血压(BP)、脉搏(HR)、脉搏氧饱和度(SpO_2);观察患者麻醉中肺水肿发生率,麻醉恢复期肺水肿、低氧血症的发生率。结果与D组麻醉前BP、HR、SpO_2比较,A组BP、HR升高明显,SpO_2下降明显,B、C、D组呈逐渐递减,组间比较差异有统计学意义(P<0.05);与D组患者麻醉中和麻醉恢复期BP、HR比较,A组的颇动大,B、C、D组呈逐渐递减,组间比较差异有统计学意义(P<0.05)。与D组患者麻醉中和麻醉恢复期的肺水肿和低氧血症发生率比较,A组较高,B、C、D组呈逐渐递减,组间比较差异有统计学意义(P<0.05)。结论初次进入高原的患者手术麻醉处理和平原患者不能等同,有其特殊性,通过行之有效的麻醉管理手段,可安全度过围手术期。

Objective To observe the effects of surgical anesthesia on hemodynamics of newly-arrived patients in plateau area and to investigate the anesthesia methods for this type of patients. Methods A total of 100 patients newly-arriving at plateau area,who underwent surgery,were enrolled and divided into four groups： group A which included the patients arriving within one week; group B with those arriving within two weeks; group C with those arriving within three weeks and group D with those arriving within four weeks. Blood pressure（BP）,heart rate（HR） and pulse oxygen saturation（SpO2）were observed before anesthesia, after anesthesia and during the anesthesia recovery period after 24 h postoperatively.Incidence rate of pulmonary edema during the anesthesia,and incidence rate of pulmonary edema and hyoxemia during anesthesia recovery period were observed for each group. Results As compared with those before anesthesia in group D,BP and HR were increased significantly and SpO2 was decreased significantly in group A. There was a progressive decline in group B,C,and D,and the differences between groups were statistically significant（P〈0. 05）. Compared with group D during anesthesia and anesthesia recovery period,BP and HR in group A had a large fluctuation,followed by a progressive decline in group B,C,and D. There was a significant between-group difference（P〈0. 05）. Compared with group D during anesthesia and anesthesia recovery period,the incidence of pulmonary edema and hypoxemia in group A was higher,followed by a gradual decrease in group B,C,and D,and there were significant differences between groups（P〈0. 05）. Conclusion The surgical anesthesia of patients arriving at plateau area for the first time is special,as compared with that in plain areas.Therefore,effective anesthesia management can help patients survive the perioperative period safely.