摘要
目的评价预注万汶对腰硬联合麻醉(CSEA)下行全髋置换术的老年患者血流动力学的影响。方法拟行全髋关节置换术的老年患者50例,随机分为两组(V组和R组),每组25例,两组分别于麻醉前1小时在病房输注万汶和乳酸林格氏液5～8 ml/kg。两组患者均采用健侧卧位行CSEA麻醉,以0.1 ml/s的速度向蛛网膜下腔注入0.5%轻比重布比卡因1.5 ml。记录麻醉前(T0)、注药完毕后3 min(T1)、6 min(T2)、9 min(T3)、12 min(T4)、15 min(T5)的SBP、DBP、MAP和HR。记录心血管不良事件的发生情况及使用麻黄碱或阿托品的次数。结果与V组对应值比较,R组SBP在T2、T3时及MAP在T2时均降低,差异有统计学意义(P<0.05)。V组低血压的发生率在T1～5较R组低,差异有统计学意义(P<0.05),两组患者心率比较差异无统计学意义(P>0.05)。结论麻醉前1小时预注万汶更有利于维持老年患者腰硬联合麻醉下行全髋置换术血流动力学的稳定。
Objective To evaluate the effects of voluven preload on hemodynamics in elderly patients undergoing total hip replacement during combined spinal epidural anesthesia.Methods 50 ASA Ⅱ or Ⅲ elderly patients of both sexes aged 69～92 yr heigth 155～182 cm and weighing 43～92kg scheduled for selective total hip replacement were randomly allocated into two groups（n=25 each）,Voluven group（group V） and Lactated Ringer＇s solution group（group R）.Voluven was infused in group V in ward at 1 hour before anesthesia and Lactated Ringer＇s solution was infused in group R.Combined spinal epidural anesthesia was performed at the L3～4 interspace with the patient in the contralateral position.Both groups received intrathecal 0.5% hyperbaric bupivacaine 1.5 ml at a rate of 0.1 ml/s.SBP,DBP,MAP and HR were assessed before anesthesia（T0）,at 3min（T1）,6 min（T2）,9 min（T3）,12 min（T4）and 15 min（T5） after anesthesia.Adverse effects,total times of use of ephedrine and atropine were recorded.Results Compared with group V,MAP at the time of T2 and SBP at the time of T2 and T3 were significantly lower that in group R（P0.05）.The incidence of hypotension at T1-5 was significantly lower that in group V than in group R（P0.05）.There were no significant differences of change in heart rate between the two groups（P0.05）.Conclusion Voluven preload at 1 hour before anesthesia could maintain the stable hemodynamics in the elderly patients undergoing total hip replacement during combined spinal epidural anesthesia.
出处
《西部医学》
2010年第12期2231-2233,共3页
Medical Journal of West China
关键词
万汶
血流动力学
腰硬联合麻醉
老年
全髋置换术
Voluen
Hemodynamic
Combined spinal epidural anesthesia
CSEA
Geriatrics
Total hip replacement
