本文選題：腰硬聯(lián)合麻醉　切入點(diǎn)：高齡　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的總結(jié)腰硬聯(lián)合麻醉用于75歲以上高齡患者的臨床經(jīng)驗(yàn)，為臨床高齡患者麻醉方式選擇提供參考。 方法對(duì)我院于2013年1~11月期間，56例采用腰硬聯(lián)合麻醉高齡患者的臨床資料進(jìn)行回顧性分析，重點(diǎn)收集麻醉起效和維持時(shí)間，麻醉中血液動(dòng)力學(xué)變化情況，麻醉中輔助藥物使用情況及并發(fā)癥等資料。 結(jié)果蛛網(wǎng)膜下腔注藥后平均54s(5410)開(kāi)始出現(xiàn)麻醉平面，平均5.8min（5.81.2）后麻醉平面固定，阻滯平面上界胸8～胸10。腰麻阻滯時(shí)間60-150（7726）min，，手術(shù)時(shí)間40-180（7735）min。與T0（麻醉前基礎(chǔ)值）比較，麻醉后平均動(dòng)脈壓有所下降（P＜0.05），但都在正常范圍。麻醉中患者生命體征平穩(wěn)，全部在腰-硬聯(lián)合麻醉下順利完成手術(shù)。術(shù)中有1例患者因MAP過(guò)低需要給予麻黃堿糾正；有1例患者M(jìn)AP升高超過(guò)麻醉前基礎(chǔ)值30%需要降壓處理；另有1例患者出現(xiàn)心率低于55次/min，給予阿托品0.5mg后糾正，其余患者術(shù)中生命體征穩(wěn)定。麻醉中未觀察到明顯呼吸抑制，脈搏氧飽和度均維持于96%以上。有9例患者術(shù)中經(jīng)硬膜外導(dǎo)管追加了局麻藥，有21例患者術(shù)中給予了芬太尼、咪達(dá)唑侖或丙泊酚輔助�；颊咝g(shù)畢未觀察到惡心、嘔吐、頭痛等現(xiàn)象，未觀察到明確麻醉并發(fā)癥。 結(jié)論腰硬聯(lián)合麻醉可安全用于高齡患者，其起效迅速，效果完善，麻醉中生命體征穩(wěn)定，充分的麻醉前準(zhǔn)備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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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