老年患者腰-硬联合麻醉下肾移植手术期血流动力学及凝血功能变化

目的探讨老年患者腰-硬联合麻醉下肾移植患者手术期血流动力学及凝血功能的变化。方法30例61-72岁。肾移植患者，分别于麻醉前（T1）、肾静脉吻合即刻（T2）、供肾动静脉（A—V）血流开放后5分钟（T3）、手术结束时（T4）．各时点监测平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、血小板计数（PLT）、凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、激活凝血时间（ACT）、纤维蛋白原（FBG）及凝血弹性图（Thromboelastograph，TEG）的变化。结果所有患者MAP、CVP在A—V血流开放后5min时较开放前降低（P〈0．05），HR在A-V血流开放后5min时较开放前增快（P〈0．05），经扩容等处理后，MAP回升，HR减慢；SpO2术中保持稳定。PLT、ACT、APTT在围术期各时点的无明显变化，FBG在A—V开放后5min有所下降；PT在开放后及术毕有增加，但在正常值范围。TEG各参数在围术期各时点显示基本正常。结论老年患者腰硬联合麻醉下肾移植术期血流动力学基本稳定，凝血功能各指标变化随手术步骤而有所改变，但基本在正常范围内。

The change of hemodynamics and coagulation function in elder patients during kidney transplantation under combined Spinal-Epidural anesthesia

Objective To investigate the change of hemodynamics and coagulation function in elder patients during kidney transplantation under Combined Spinal-Epidural Anesthesia. Methods 30 patients scheduled for kidney transplantation, aged from 61-72 were studied. The change of their hemodynamic parameters such as mean arterial pressure （MAP）, center venous pressure （CVP）, heart rate （HR）, platelet count （PLT）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, activated coagulation time （ACT）, fibrinogen （FBG） and thromboelastogram （TEG） were monitored and recorded at the points of before anesthesia （T1）, the beginning of vein anastomosis （T2）, 5 minutes after the opening the arterial and vein blood for reperfusion of the donor kidney （T3） and the end of surgery（T4） respectively. Results The MAP and CVP in all patients at T3 were lower than that at the point of before the opening arterial and vein blood （T5） （P〈0. 05）; HR at T3 were faster than that at T5 （P〈0.05）. After blood volume expansion, the MAP and the HR were returned to normal level. SpO2 was stable during the operation. PLT, ACT and APTT were not changed obviously at each time points; FBG decreased a little at T3, PT increase a little, but there were still in the normal range at T3 and T4. TEG kept normal range at each point. Conclusion Above data indicate that the hemodynamics and the coagulation function can be maintained in the normal range for the elder patients during the kidney transplantation under combined Spinal-Epidural anesthesia.