不同的预处理对老年患者经尿道前列腺电切术体位性低血压的效果

目的 评价不同的预处理方法防治老年患者经尿道前列腺电切术(TURP)体位性低血压的效果.方法 将90例择期行TURP老年患者按随机数字表法分为弹力绷带组、间羟胺组及未处理组,每组30例.所有患者均行腰硬联合麻醉,手术结束后先将一侧下肢缓慢放平,暂停1 min后,同一方法放平另一侧下肢.弹力绷带组采用医用弹力绷带将双下肢自足外踝螺旋包扎至大腿中上部,然后摆截石位进行手术,术后放平双下肢5 min后去除弹力绷带:间羟胺组在手术结束后放下一侧下肢1 min前给予间羟胺0.3 mg静脉推注；未处理组未采用任何干预.观察并记录3组患者手术结束后改平卧位前(T1)、即刻平卧(T2)以及改平卧位后5(T3)、10 min(T4)的收缩压(SBP),平均动脉压(MAP)及心率的变化.结果 弹力绷带组及间羟胺组患者体位改变前后各时段SBP及MAP均无明显变化(均P＞0.05)；未处理组T2、T3、T4的SBP及MAP较T1均明显下降(均P＜0.05).弹力绷带组及未处理组T2、T3及T4的心率较T1均明显增快,间羟胺组心率明显减慢(均P＜0.05).结论 老年患者TURP术后在体位改变前给予间羟胺0.3 mg静脉推注预处理可减轻血压的波动,对防治体位性低血压有一定的应用价值.

Effects of Different Preconditioning Regimens on Postural Hypotension in Elderly Patients Undergoing Transurethral Resection of the Prostate

Objective To evaluate the effects of different preconditioning regimens on hypotension in elderly patients undergoing transurethral resection of the prostate （TURP）. Ninety elderly patients scheduled for TURP were randomly divided into three groups： elastic postural Methods bandage group, metaraminol group and control group, with 30 patients in each group. All patients received combined spinal-epidural analgesia. After operation, one of both lower limbs was slowly returned to the horizontal position, and the other was returned to the horizontal position after 1 minute. In elastic bandage group, medical elastic bandage was applied from the lateral malleolus to the upper part of the thigh and patients were placed in the lithotomy position during surgery. Elastic bandage was removed 5 minutes after both lower limbs were returned to the horizontal position. In metaraminol group, 0.3 mg metaramin01 was intravenously injected 1 minute before one of both lower limbs was returned to the horizontal position. Patients in control group received no pretreatment. The systolic blood pressure （SBP）, mean arterial pressure （MAP） and heart rate were recorded before （T 1 ） and 0 （T2）, 5 （T3） and 10 minutes （T4）after patients were placed in the supine position. Results There were no significant differences in SBP and MAP among different time points in elastic bandage group and metaramiqol group（P〉0.05）. Compared with T1, SBP and MAP in control group and heart rate in metaraminol groupsignificantly decreased, but heart rate in elastic bandage group and control group obviously increased at T2, T3 and T4 （all P〈0.05）. Conclusion Intravenous injection of 0.3 mg metaraminol before body position change can stabilize blood pressure in elderly patients undergoing TUPR. Therefore, metaraminol pretreatment is valuable in the nreve, ntinn Anti treatment of postural hypotension.