腰硬联合麻醉用于75岁以上高龄患者的回顾性总结

发布时间：2018-03-14 17:25

本文选题：腰硬联合麻醉　切入点：高龄　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的总结腰硬联合麻醉用于75岁以上高龄患者的临床经验，为临床高龄患者麻醉方式选择提供参考。方法对我院于2013年1~11月期间，56例采用腰硬联合麻醉高龄患者的临床资料进行回顾性分析，重点收集麻醉起效和维持时间，麻醉中血液动力学变化情况，麻醉中辅助药物使用情况及并发症等资料。结果蛛网膜下腔注药后平均54s(5410)开始出现麻醉平面，平均5.8min（5.81.2）后麻醉平面固定，阻滞平面上界胸8～胸10。腰麻阻滞时间60-150（7726）min，，手术时间40-180（7735）min。与T0（麻醉前基础值）比较，麻醉后平均动脉压有所下降（P＜0.05），但都在正常范围。麻醉中患者生命体征平稳，全部在腰-硬联合麻醉下顺利完成手术。术中有1例患者因MAP过低需要给予麻黄碱纠正；有1例患者MAP升高超过麻醉前基础值30%需要降压处理；另有1例患者出现心率低于55次/min，给予阿托品0.5mg后纠正，其余患者术中生命体征稳定。麻醉中未观察到明显呼吸抑制，脉搏氧饱和度均维持于96%以上。有9例患者术中经硬膜外导管追加了局麻药，有21例患者术中给予了芬太尼、咪达唑仑或丙泊酚辅助。患者术毕未观察到恶心、呕吐、头痛等现象，未观察到明确麻醉并发症。结论腰硬联合麻醉可安全用于高龄患者，其起效迅速，效果完善，麻醉中生命体征稳定，充分的麻醉前准备和完善的麻醉管理措施，有助于保障麻醉安全性。
[Abstract]:Objective to summarize the clinical experience of combined spinal-epidural anesthesia in elderly patients over 75 years old. Methods the clinical data of 56 elderly patients with combined spinal-epidural anesthesia from 2013 to November in our hospital were retrospectively analyzed. The onset and maintenance time of anesthesia and hemodynamic changes during anesthesia were collected. Information on the use of auxiliary drugs and complications during anesthesia. Results Anesthesia level began to appear after subarachnoid injection (mean 5. 8 min and 5. 81.2). After anesthesia level was fixed, chest was 8 ~ 10. The time of spinal anesthesia was 60-150 ~ 7726 min, the operative time was 40-180 ~ 7735 min. Compared with T0 (base value before anesthesia), the anesthesia level was fixed. After anesthesia, the mean arterial pressure was decreased (P < 0.05), but all were in the normal range. The vital signs of the patients were stable and all the patients were successfully operated under the combined spinal-epidural anesthesia. One patient needed to be corrected by ephedrine because of the low MAP during the operation. In one case, the increase of MAP exceeded the baseline value of 30% before anesthesia, and in another case, the heart rate was less than 55 beats / min and corrected with atropine 0.5mg. The vital signs of the remaining patients were stable and no significant respiratory inhibition was observed during anesthesia. Pulse oxygen saturation was maintained above 96%. Local anesthetic was added through epidural catheter in 9 patients, and fentanyl, midazolam or propofol was used in 21 patients. Nausea and vomiting were not observed at the end of operation. Headache and other phenomena, no clear anesthetic complications were observed. Conclusion Spinal-epidural anesthesia can be safely used in elderly patients with rapid onset, perfect effect, stable vital signs, adequate preparation before anesthesia and perfect anesthetic management measures, which is helpful to ensure the safety of anesthesia.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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