老年病人连续腰麻后血液流变学的改变

目的:观察老年病人连续腰麻(CSA)后血液流变学状态的改变。方法:20例下肢手术老年病人,连续腰麻穿刺置管,给予0.375%布比卡因重比重液,分别于麻醉前(T0)、麻醉后1 h(T1)、术毕(T2)、术后24 h(T3)、术后48 h(T4)各时间点采血行血液流变学检测。结果:全组病人红细胞压积、全血中切粘度于T2-T4期(P<0.05或0.01);血沉方程K值T2期(P<0.05),血浆粘度T2-T3期;全血高切粘度、低切粘度、红细胞聚集指数T3-T4期(P均<0.01);纤维蛋白原T1-T4期均低于麻醉前(P<0.05或0.01);而红细胞变形指数和刚性指数则在整个围术期无改变。结论:连续腰麻可以改善老年病人血液流变学状态,有利于减少围术期血栓性并发症,对保障围术期老年病人的安全性有益。

Hemorheological Changes During Continous Spinal Anesthesia in Elderly Patients

Objective To observe the change of hemorheology during continous spinal anesthesia(CSA) in elderly patients. Methods Twenty ASAⅠ-Ⅲ patients aged 65-90 years were premedicated with intramuscular diazepam 5 mg and scopolamine 0.3 mg,then CSA was performed.Hyperbaric 0.375% bupivacaine solution was injected.Hemorheological parameters were measureded at following time point:before anesthesia(T0),1 h after anesthesia(T1),at the end of surgery(T2),24 h(T3) and 48 h(T4) after the operation.Results The hematocrit of red blood cells and whole blood viscosity at moderate shear rate from T2 to T4(P<0.05),erythrosedimentation(ESR) equation quotient(K) at T1(P<0.01),plasma viscosity from T2 to T3,erythrocyte aggregation and whole blood viscositie at low and high shear rate from T3 to T4 fibrinogen from T1 to T4(P<0.05 or 0.01)were all significantly decreased compared with that at T0,while the erythrocyte deformability was not changed during the operation.Conclusion CSA can improve the state of hemorheology in elderly patients,which is beneficial to decrease the ratio of the complication of deep vein thrombosis.