冠心病患者上腹部手术不同麻醉处理的临床分析

Clinical Analysis of Different Anesthetic Treatments in Upper Abdominal Surgery in Patients With Coronary Heart Disease

目的分析冠心病患者上腹部手术不同麻醉处理的应用效果。方法选取2021年2月—2022年4月昌吉州宝石花医院麻醉科冠心病上腹部手术患者120例,采取单双号法均分为一般组及分析组。一般组患者采取气管插管全身麻醉,分析组患者实施全麻联合硬膜外麻醉。对比两组不同时刻(T0:麻醉前;T1:麻醉诱导后;T2:气管插管时;T3:开腹时;T4:拔管后)的心率、摄氧量、二氧化碳排出量、每搏输出量、平均动脉压、中心静脉压及不良事件(心肌梗死、心绞痛、死亡)发生率。结果T0、T1时刻,分析组与一般组心率相比差异无统计学意义(P>0.05),T2、T3、T4时刻,分析组心率显著低于一般组,差异有统计学意义(P<0.05)。T0、T1时刻,分析组与一般组摄氧量相比差异无统计学意义(P>0.05),T2、T3、T4时刻,分析组摄氧量低于一般组,差异有统计学意义(P<0.05)。T0、T1时刻,分析组二氧化碳排出量与一般组比较差异无统计学意义(P>0.05),T2、T3、T4时刻,分析组二氧化碳排出量明显低于一般组,差异有统计学意义(P<0.05)。T0、T1时刻,分析组与一般组的每搏输出量比较差异无统计学意义(P>0.05),T2、T3、T4时刻,分析组每搏输出量低于一般组,差异有统计学意义(P<0.05)。T0、T1时刻,分析组平均动脉压与一般组比较差异无统计学意义(P>0.05),T2、T3、T4时刻,分析组平均动脉压低于一般组,差异有统计学意义(P<0.05)。T0、T1时刻,分析组中心静脉压与一般组相比,差异无统计学意义(P>0.05),T2、T3、T4时刻,分析组中心静脉压低于一般组,差异有统计学意义(P<0.05)。分析组不良事件(心肌梗死、心绞痛、死亡)发生率低于一般组,差异有统计学意义(P<0.05)。结论冠心病患者上腹部手术中采取全麻联合硬膜外阻滞可提高患者的麻醉安全性,减少不良事件发生。

Objective To analyze the effect of different anesthesia in upper abdominal surgery in patients with coronary heart disease.Methods A total of 120 patients receiving upper abdominal surgery for coronary heart disease in the department of anesthesiology,Changji Gem Flower Hospital from February 2021 to April 2022 were selected,they were divided into general group and analysis group by odd-even number method.The general group received tracheal intubation general anesthesia,and the analysis group received general anesthesia combined with epidural anesthesia.The heart rate,oxygen uptake,carbon dioxide output,stroke output,mean arterial pressure,central venous pressure at different times(T0:before anesthesia;T1:after anesthesia induction;T2:during endotracheal intubation;T3:laparotomy;T4:after extubation)and,incidence of adverse events(myocardial infarction,angina,death)were compared between the two groups.Results At T0 and T1,there were no statistically significant differences in heart rate between the analysis group and the general group(P>0.05);at T2,T3 and T4,the heart rate of the analysis group were significantly lower than that of the general group,the differences were statistically significant(P<0.05).At T0 and T1,there were no statistically significant differences in oxygen uptake between the analysis group and the general group(P>0.05);at T2,T3 and T4,the oxygen uptake of the analysis group were lower than that of the general group,the differences were statistically significant(P<0.05).At T0 and T1,there were no statistical significant differences in carbon dioxide emission between the analysis group and the general group(P>0.05);at T2,T3 and T4,carbon dioxide emission in the analysis group were significantly lower than that in the general group,the differences were statistically significant(P<0.05).At T0 and T1,the stroke output of the analysis group werenot significantly different from that of the general group(P>0.05),but at T2,T3 and T4,the stroke output of the analysis group were lower than that of the general group,the differences were statistically significant(P<0.05).At T0 and T1,the mean arterial pressure in the analysis group were not significantly different from that in the general group(P>0.05),while at T2,T3 and T4,the mean arterial pressure in the analysis group were significantly lower than that in the general group,the differences were statistically significant(P<0.05).At T0 and T1,there were no statistically significant differences in central venous pressure between the analysis group and the general group(P>0.05);at T2,T3 and T4,central venous pressure in the analysis group were lower than that in the general group,the differences were statistically significant(P<0.05).The incidence of adverse events(myocardial infarction,angina pectoris,death)in the analysis group was lower than that in the general group,the difference was statistically significant(P<0.05).Conclusion General anesthesia combined with epidural block can improve the safety of anesthesia and reduce the occurrence of adverse events in upper abdominal surgery in Patients With Coronary Heart Disease.