老年患者麻醉中连续监测足背动脉有创血压的临床意义

目的观察老年患者麻醉中足背动脉有创血压的变化规律,探索并为临床提供一种麻醉中稳定循环的依据。方法选择术前能配合治疗,足背无穿刺禁忌,足趾无缺血坏死,胫后足底动脉代偿良好,ASAⅠ~Ⅲ级,60岁以上的择期胸腹部手术,手术时间预计2h以上的拟行全身麻醉患者99例（男51,女48）,其中腹部盆腔手术62例。建立足背动脉有创血压后,连续观察并记录麻醉前、麻醉诱导中最低,麻醉诱导插管后即刻,切皮前最低,切皮前即刻,术中最高最低,术毕,拔管前后及清醒后的有创血压和右肱动脉无创血压（收缩压SBP舒张压DBP平均动脉压MBP）值;腹部盆腔手术术中有创血压值异常例数及时间。结果与麻醉前比较：术中有创血压和右肱动脉无创血压值都有降低,最低值多数发生在麻醉诱导中,3%（3/99）发生在术中,有创血压比右肱动脉无创血压值波动幅度大;有创血压和右肱动脉无创血压值相比：有创血压变化快,麻醉前、麻醉诱导插管后即刻、术中最高、拔管前后及清醒后,SBP值较高（P〈0.05）,麻醉诱导中最低SBP、DBP、MBP值较低（P〈0.05）;腹部盆腔手术术中有创血压值异常发生率74%（46/62）。结论老年患者麻醉中足背动脉有创血压的变化幅度大,特别是SBP,对影响循环的因素反应敏感,围术期监测循环系统及时精确,是麻醉中稳定循环的可靠依据,该监测方法值得推荐。

The clinical significance of continuous monitoring invasive blood pressure of foot dorsal artery in elderly patients un dergoing anesthesia.

Objective To observe the changes of invasive blood pressure of foot dorsal artery in elderly patients undergoing anesthesia,and to provide an exact proof of stable circulation during operation.Methods 99 cases（male 51,female 48）,ASA Ⅰ ~ Ⅲ,older than 60 years,undergone elective thoracic and abdominal operation were involved.Continuous observation the blood pressure after the establishment of invasive dorsal artery catheter at the following points： before anesthesia,the lowest value during induction,after the intubation,the lowest value before skin incision,skin incision,the highest and lowest value during operation,the end of operation,before extubation,after extubation and awake;we also record the noninvasive blood pressure as comparison.Record the number of cases and continued time that have abnormal invasive blood pressure.Results Both invasive and non-invasive blood pressure are reduced after induction,most of the lowest value occurred during the induction,only 3%（3 /99） occurred during the operation.The amplitude variation of invasive blood pressure changes more and quickly than of noninvasive blood pressure,the rate of abnormal invasive blood pressure values in pelvic operation is 74%（46 / 62）.Conclusion The foot dorsal artery invasive blood pressure,especially SBP,in elderly patients anesthesia changes more and sensitives to the changes of circulation,it is timely and accurately to perioperative,and is a reliable method to monitor circulation changes during anesthesia this monitoring method is recommended.