摘要
目的 探讨体外腹主动脉按压对老年患者麻醉诱导时循环的影响.方法 采用前瞻性随机对照研究方法,将2017年1月至4月武警总医院收治的美国麻醉医师协会（ASA）分级Ⅱ~Ⅲ级、拟行全麻非腹部手术的60~75岁老年患者按随机数字表法分为腹主动脉按压组和对照组,每组20例.两组均予以咪唑安定、丙泊酚、芬太尼和顺式阿曲库铵诱导麻醉,丙泊酚、瑞芬太尼、顺式阿曲库铵维持麻醉,插管成功后接麻醉机行机械通气;腹主动脉按压组则在咪唑安定注入1 min后给予腹主动脉按压至插管后5 min.分别于麻醉诱导前、诱导后、插管后即刻、插管后5 min和10 min监测平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（SpO2）等,观察低血压、心动过缓等不良反应发生情况和麻黄碱、阿托品的使用情况.结果 腹主动脉按压组和对照组患者麻醉诱导前MAP〔mmHg（1 mmHg=0.133 kPa）：83.6±4.7、82.9±4.7〕、HR（次/min：67.3±5.9、65.9±5.7）、SpO2（0.962±0.007、0.960±0.009）差异均无统计学意义（均P〉0.05）.麻醉诱导后,对照组MAP、HR较诱导前明显下降〔MAP（mmHg）：70.0±8.7比82.9±4.7,HR（次/min）：60.7±6.7比65.9±5.7,均P〈0.05〕,且明显低于腹主动脉按压组〔分别为（83.1±3.9）mmHg、（66.8±4.9）次/min,均P〈0.05〕.气管插管后即刻,对照组MAP、HR较麻醉诱导后明显升高〔MAP（mmHg）：78.9±7.9比70.0±8.7,HR（次/min）：67.3±2.7比60.7±6.7,均P〈0.05〕,而腹主动脉按压组MAP、HR变化不明显.两组麻醉诱导期间SpO2变化差异无统计学意义.对照组麻醉诱导期间4例出现低血压,其中2例使用了麻黄碱;2例出现心动过缓并使用了阿托品.而腹主动脉按压组麻醉诱导期间未见不良反应发生.结论 老年患者麻醉诱导时行腹主动脉按压有助于维持血流动力学稳定.
Objective To investigate the effect of external abdominal aorta compression on circulation during anesthetic induction in elderly patients. Methods A prospective randomized controlled trial was conducted. Patients with age of 60-75 years old, requiring a general anesthesia for non-abdominal surgery, and with Ⅱ-Ⅲ class of American Society of Anesthesiologists （ASA） physical status classification, and admitted to General Hospital of Chinese People＇s Armed Police Forces from January to April in 2017 were enrolled. They were divided into abdominal aorta pressure group and control group according to random number method, with 20 patients in each group. In both groups, anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium, and was maintained with propofol, remifentanil and cisatracurium. After successful intubation, the anesthesia machine was changed into mechanical ventilation. The patients in abdominal aorta pressure group were given abdominal aorta pressure 1 minute after induction of general anesthesia with midazolam till 5 minutes after intubation. The mean arterial pressure （MAP）, heart rate （HR） and blood oxygen saturation （SpO2） were observed before anesthesia induction, immediately after anesthesia induction, immediately after intubation, 5 minutes and 10 minutes after intubation, respectively. The incidence of hypotension or bradycardia, and usage of ephedrine or atropine were recorded. Results There were no significant differences in MAP [mmHg （1 mmHg = 0.133 kPa）： 83.6±4.7 vs. 82.9±4.7], HR （bpm： 67.3±5.9 vs. 65.9±5.7） and SpO2 （0.962±0.007 vs. 0.960±0.009） before anesthesia induction between abdominal aorta pressure group and control group （all P 〉 0.05）. Immediately after anesthesia induction, the MAP and HR in control group were significantly decreased as compared with those before anesthesia induction [MAP （mmHg）： 70.0±8.7 vs. 82.9±4.7, HR （bpm）： 60.7±6.7 vs. 65.9±5.7, both P 〈 0.05], and they were also significantly lower than those of abdominal aorta pressure group [MAP （mmHg）： 83.1±3.9, HR （bpm）： 66.8±4.9, both P 〈 0.05]. Immediately after intubation, the MAP and HR in control group were significantly increased as compared with those immediately after anesthesia induction [MAP （mmHg）： 78.9±7.9 vs. 70.0±8.7, HR （bpm）： 67.3±2.7 vs. 60.7±6.7, both P 〈 0.05], but the changes in MAP and HR in abdominal aorta pressure group were not obvious. During the anesthesia induction period, there was no statistical difference in SpO2 change between the two groups. During induction of anesthesia, no adverse reaction was found in the abdominal aorta pressure group, but 4 patients with hypotension and 2 patients with bradycardia were found in the control group. Two patients with hypotension were treated with ephedrine, and 2 patients with bradycardia were treated with atropine. Conclusion Anesthesia induction of elderly patients with abdominal aorta pressure can help maintain hemodynamic stability.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第7期629-632,共4页
Chinese Critical Care Medicine
基金
全军医学科研“十二五”课题计划项目（BWS11J077）
关键词
腹主动脉按压
麻醉
血流动力学
老年
Abdominal aorta compression
Anesthesia
Hemodynamics
Elderly patient
