高龄患者腰-硬联合麻醉前预输转化糖复合参附的临床意义

目的观察高龄手术患者腰硬联合麻醉预输转化糖复合参附注射液对麻醉期间血流动力学的影响。方法择期行下肢骨折手术高龄患者80例,随机分为治疗组(Ⅰ组:麻醉前预输转化糖液200 ml+参附注射液50 ml)和对照组(Ⅱ组:麻醉前预输5%葡萄糖液250 ml),每组各40例。分别于麻醉前(T0)和麻醉后5(T1)1、0(T2)1、5(T3)、30 min(T4)等时点测量并记录HR、SBP、DBP及MAP值,以及麻醉期间血管活性药物使用剂量和例数。同时观察有无恶心、呕吐的发生。结果麻醉前两组患者HR、SBP、DBP、MAP无显著差异;T1、T2、T3时点HR、SBP、MAP组间比较差异明显(P<0.05)。麻醉期间使用麻黄素Ⅱ组有9例12人次,Ⅰ组有1例1人次;使用阿托品Ⅱ组有5例6人次,Ⅰ组无人使用;麻醉后诉有头晕、恶心、呕吐感,Ⅱ组中有7例,Ⅰ组1例;两组相比有明显差异(P<0.05)。结论转化糖复合参附注射液麻醉前预先输注,能在一定程度上改善高龄患者腰-硬联合麻醉期间血流动力学的稳定性,减少术中心血管活性药物的使用,且能减少恶心、呕吐的发生。

Effect of invert sugar and shen-fu pre-injection before combined spinal epidural anaesthesia in elderly patients

Aim To observe the effects of invert sugar and shen-fu injections on efficacy of hemo-dynamics in elderly patients with combined spinal epidural anaesthesia（CSEA）.Methods Eighty ASA Ⅱ～Ⅲ patients aged 70~85 yr,weighting 50~82 kg undergoing surgical intervention for low extremity fracture,were equally randomized into treatment group（groupⅠ） and control group（groupⅡ）.Before anaesthesia,groupⅠadded shenfu 50 ml to invert sugar 200 ml for intravenous drop infusion,while groupⅡ received 5%250 ml glucose injection for infusion.Both group were dropped over within 20 min.The change of HR,SBP,DBP,MAP were taken and recorded before anaesthesia（T0）,and 5 min（T1）,10 min（T2）,15 min（T3）,30 min（T4） after anaesthesia,and the numbers of patients to use vasoactive drugs also recorded.Results During T0 HR,SBP,DBP,MAP of the patients had no difference in the two groups.Compared with groupⅡ,HR,SBP,DBP,MAP had significant difference at T1,T2,T3（P0.05）after anaesthesia.The ephedrine and atropine consumption after anaesthesia was higher in groupⅡthan in groupⅠ（P0.05）.Adverse effects had significant difference between the two groups.Conclusion Pre-injection of invert sugar zhuan-hua-tang combined shen-fu has great significant effect to maintain hemo-dynamics stability in elderly patients with CSEA,which could reduce vasoactive drugs consumption during anaesthesia and decrease the incidence of nausea and vomiting.