老年患者腹股沟斜疝丙泊酚麻醉术后低血压危险因素分析及护理

Hazards and Nursing of Elderly Patients with Hypotension after Propofol for Indirect Inguinal Hernia

目的:探讨老年腹股沟斜疝丙泊酚麻醉术后低血压的危险因素及护理方法。方法:将行腹股沟斜疝手术的老年男性患者100例,根据麻醉复苏期间血压分为低血压(32例)和非低血压(68例),计算麻醉时间及丙泊酚剂量判断低血压发生的ROC曲线及曲线下面积;应用多因素Logistic回归分析丙泊酚术后低血压发生的独立危险因素;针对高危患者采取强化护理。结果:低血压与非低血压在体重指数(BMI)、低密度脂蛋白胆固醇(LDL-C)、收缩压、平均压、空腹血糖、高血压病史、糖尿病史、吸烟史、麻醉时间、丙泊酚用量上比较差异有统计学意义(P<0.01)。丙泊酚剂量及麻醉时间诊断低血压的曲线下面积(AUC)分别为0.68(95%CI:0.533~0.827),0.67(95%CI:0.735~0.979)。多因素Logistic回归分析显示,LDL-C、平均压、麻醉时间、丙泊酚剂量为高龄患者丙泊酚麻醉术后复苏发生低血压的独立危险因素(P<0.05)。结论:腹股沟斜疝丙泊酚麻醉复苏期间低血压的发生与麻醉时间、丙泊酚剂量、LDL-C及平均压有关,在麻醉复苏室应予以强化护理。

Objective:To explore the risk factors and nursing methods of hypotension after anesthesia in elderly patients with inguinal hernia.Methods:Elderly men undergoing inguinal hernia surgery were divided into low blood pressure group(32 cases)and non-hypotension group(68 cases)according to the blood pressure during anesthesia resuscitation.The ROC curve and curve of hypotensive occurrence were calculated by calculating anesthesia time and propofol dose.Multivariate Logistic regression analysis was used to analyze the independent risk factors of postoperative hypotension after propofol,and intensive care was carried out for high-risk patients.Results:There were significant differences between hypotension and non hypotension in BMI,LDL-C,systolic blood pressure,mean pressure,fasting blood glucose,hypertension history,diabetes history,smoking history,anesthesia time,and propofol dosage(P<0.01).The area under the curve(AUC)of propofol dosage and anesthesia time for diagnosing hypotension was 0.68(95%CI:0.533~0.827)and 0.67(95%CI:0.735~0.979)respectively.Multiple factor Logistic regression analysis showed that LDL-C,mean pressure,time of anesthesia and propofol were independent risk factors for hypotension after propofol anesthesia in elderly patients(P<0.05).Conclusion:Hypotension during the resuscitation of propofol in the inguinal hernia is related to the time of anesthesia,the dose of propofol,the LDL-C and the mean pressure,and the intensive care should be given in the anaesthesia resuscitation room.