三种麻醉方式对择期腹部手术老年冠状动脉粥样硬化性心脏病患者血流动力学指标及心电活动的影响

Effects of three different anesthetic methods on cardiac hemodynamics and cardiac electrical activity in elderly patients with coronary heart disease undergoing elective abdominal surgery

目的观察三种麻醉方式对择期腹部手术老年冠状动脉粥样硬化性心脏病(以下简称冠心病)患者血流动力学指标以及心电活动的影响.方法选取2017年3月至2019年4月在山西医科大学汾阳医院进行择期腹部手术治疗的老年患者103例,根据麻醉方案将其分为硬膜外麻醉组(EA组)30例、全身麻醉组(GA组)35例及腰-硬联合麻醉组(CSEA组)38例.对比三组麻醉前(T0)、麻醉后5 min(T1)、麻醉后15 min(T2)、麻醉后30 min(T3)、麻醉后60 min(T4)及术毕(T5)时心电图(ECG)指标(ST段改变及心律失常)、血流动力学指标[平均动脉压(MAP)及动脉血氧饱和度(SaO2)]变化.结果T2、T3、T4时点,CSEA组的MAP水平高于EA组(P<0.05);T2、T3时点,CSEA组、GA组SaO2水平高于EA组(P<0.05);CSEA组、GA组的ST段改变、心律失常发生率均低于EA组(P<0.05).结论对择期腹部手术的老年冠心病患者采取全身麻醉或腰-硬联合麻醉,对其心电图以及血流动力学指标影响更小.

Objective To observe the effects of three different anaesthesia methods on cardiac hemodynamics and cardiac electrical activity in elderly patients with coronary heart disease(CHD)undergoing elective abdominal surgeiy.Methods A total of 103 elderly patients undergoing elective abdominal surgery in Fenvang Hospital of Shanxi Medical University from March 2017 to April 2019 were selected and divided into epidural anesthesia(EA)group(n=30),general anesthesia(GA)group (n=35)and combined spinal-epidural anesthesia(CSEA)group(n=38)according to the anesthesia regimen.The electrocardiogram(ECG)including ST segment changes and arrhythmia,and hemodynamic indicators,such as mean arterial pressure(MAP),oxygen saturation(SaO2),were compared among each group before anesthesia(TO),5 min after anesthesia(T1),15 min after anesthesia(T2),30 min after anesthesia(T3),60 min after anesthesia(T4)and after operation(T5).Results At T2,T3 and T4 time points,the level of MAP in CSEA group was significantly higher than that in EA group(P<0.05).At T2 and T3 time points,the levels of SaO2 in CSEA and GA group were significantly higher than those in EA group(P<0.05).The incidences of ST segment changes and arrhythmia in CSEA group and GA group were lower than those in EA group(P<0.05).Conclusions General anesthesia and combined spinal-epidural anesthesia has less effects on ECG and hemodynamic parameters in elderly patients undergoing elective abdominal surgery.