摘要
目的观察琥珀酰明胶注射液（商品名：佳乐施）预扩容对老年人腰硬联合麻醉（CSEA）下行经尿道前列腺汽化电切术（TVP）血流动力学的影响。方法择期行TVP术的老年病人60例，按美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，随机分为预输注佳乐施组（G组），乳酸钠林格液组（R组），每组各30例。麻醉前分剐以15ml／（kg·h）的速度输入佳乐施或乳酸钠林格氏液500ml，麻醉后2组病人输液管理相似。观察麻醉后5、15、30、45min各时点病人的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、中心静脉压（CVP）的变化，记录发生低血压、恶心呕吐及应用麻黄碱的例数。结果 2组扩容后MAP、CVP有所升高，但均在正常范围内。麻醉后15、30、45min各时点R组的MAP、CVP与G组比较明显降低（P〈0．05），G组的血流动力学稳定，R组发生低血压、恶心呕吐及应用麻黄碱的例数多于G组（P〈0．05）。结论老年人在腰硬联合麻醉下行TVP术，预输注佳乐施能保持病人术中血流动力学稳定，减少低血压、恶心呕吐等不良反应的发生率。
Objective To observe the effects of pre-anesthetic volume expansion with gelofusine on hemodynamies in the elderly undergoing transurethral electrovaporizatiou of prostate （TVP） during combined spinal-epidural anesthesia （CSEA）. Methods Sixty aged patients （ASA Ⅰ-Ⅱ） undergoing selective TVP were randomly divided into two groups： group gelofusine（group G,n = 30） and group Lactated Ringer＇s Solution （group R,n = 30）. Before anesthesia, the patients were infused with 500 ml gelofusine （group G）or Lactated Ringer＇s Solution （group R） respectively at the rate of 15 ml/（ kg · h）. CSEA were performed at L3-4 interspace. After anesthesia, fluid management was similar in both groups, the changes of SBP, DBP, MAP, HR, SpO2, CVP at time of 5, 15, 30, 45 min after the anesthesia were observed in each group, and the incidence of hypotension and the side effects such as nausea and vomiting were compared. And the cases using ephedrine were recorded either. Results The levels of MAP and CVP of two groups increased after volume expansion, but remained within the normal range. The levels of MAP and CVP of group R were significantly less than those in group G during operation（ P 〈 0. 05 ）. The incidence of hypotension and the number of cases using ephedrine of group R were significantly higher than those in group G （ P 〈 0. 05 ）. Conclusions Pre-anesthetic volume expansion with gelofusine can not only maintain stable hemodynamies hut also efficiently decrease the incidenee of side effects in aged patients undergoing TVP during CSEA.
出处
《实用老年医学》
CAS
2008年第5期346-348,共3页
Practical Geriatrics
基金
上海市嘉定区卫生局科研项目(KYXM-2006-11-02)
关键词
预扩容
佳乐施
腰硬联合麻醉
经尿道前列腺汽化电切术
老年人
血流动力学
volume expansion
gelofusine
combined spinal-epidural anesthesia
transurethral electrovaporizationof prostate
aged
hemodynamic
