摘要
【目的】观察七氟烷低流量麻醉对行择期开腹手术老年患者的血流动力学、肝肾功能与血气指标的影响。【方法】选择行择期开腹手术的老年患者20例，AsA分级Ⅱ～Ⅲ级，年龄〉65岁，随机分为A（低氧流量组）、B（高氧流量组）两组，每组10例。两组患者的麻醉诱导均采用静脉快速诱导，气管插管后行机械通气，七氟烷挥发罐调至2％，A组氧流量调至0．5L／min，B组氧流量调至4L／min，同时予瑞芬太尼静脉泵入。监测并记录所有患者插管后10min（T0）、术中1h（T1）、术中2h（T2）、术毕（T3）时的心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PET CO2）、血氧饱和度（SpO2）及吸入氧浓度（FiO2），并抽取各时点桡动脉血行血气分析。术前及术后24h抽血行肝肾功能检查。【结果】A、B两组患者组间和组内各监测点的HR、MAP、Pe—CO2、SpO2、FiO2及动脉血气指标比较无明显差异（P〉0．05）。两组患者肾功能指标血肌酐（Cr）和血尿素氮（BuN）术前与术后对比无明显差异（P〉0．05）。两组患者手术前后肝功能指标丙氨酸氨基转移酶（ALT）组间比较无显著差异，组内比较患者术后ALT较术前有明显增高（P〈0．05），但ALT均未超过正常上限2倍。【结论】0．5L／min低氧流量七氟烷维持麻醉方案对行择期开腹手术的老年患者肝肾功能无明显损害，血流动力学平稳，动脉血气指标监测在正常范围，可安全用于老年患者的开腹手术麻醉。
[Objective] To observe the effect of sevoflurane for low-flow anesthesia（LFA） on hemodynamics, renal and hepatic function and arterial blood gas analysis（ABG） in elderly patients undergoing elective open abdominal surgery. [Methods]Twenty ASA II or III elderly patients（aged over 65 years old） undergoing elective open surgery were chosen and randomly divided into group A（sevoflurane low-flow group） and group B（sevoflurane high-flow group） with 10 in each. After intravenous rapid anesthesia induction, the patients were intubated and mechanically ventilated. Anesthesia was maintained with 2% sevoflurane and intravenous anesthetics. The fresh gas flow（FGF） of group A was set at 0.5L/rain and the FGF of group B was set at 4L/min. The results of HR, MAP, PETCO2, SpO2 , FiO2 and ABG were recorded at 10rain after intubation（T0）, intraoperation lh（T1 ）, intraoperation 2h（T2 ） and the end of operation（T3 ）. Renal and hepatic function were assessed 24h before and after operation. [Results] There was no significant difference in HR , MAP, PETCO2 , SpO2 , FiO2 and ABG at each checking point between group A and group B（ P 〉0.05）. There was no significant difference in renal function indicators such as alanine aminotransferase（ALT） and blood urea nitrogen（BUN） between two groups before and after operation（ P 〉0.05）. Compared with before treatment, ALT in two groups after operation significantly increased （ P d0.05）, but the rising range of ALT didn＇t double the upper normal limit. [Conclusion] Sevoflurane low-flow anesthesia with oxygen flow 0.5L/min maintenance has no obvious damage on renal and hepatic function in elderly patients undergoing elective open abdominal surgery. The hemodynamies is stable, and arterial blood gas is in the normal range. Therefore, it can be safely used in elderly patients undergoing open surgery.
出处
《医学临床研究》
CAS
2013年第5期882-884,共3页
Journal of Clinical Research
关键词
腹部
外科学
麻醉
Abdomen/SU
Anesthesia
