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ID:27756169
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时间:2018-12-05
《临床医学毕业论文两种不同麻醉方法对老年高血压患者心血管相关因素的影响》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、两种不同麻醉方法对老年高血压患者心血管相关素的影响姓名:2014年6月25日【摘要】目的比较全麻与硬膜外麻醉复合全麻两种不同的方法对老年高血压患荠围术期血清肌酸激酶(CK)和肌酸激酶同工酶(CKMB)等心血管相关因子的影响。方法上腹部择期手术老年高血压患者60例,ASAII〜m级,随机分成丙泊酚靶控输注全麻组(P组,n=30)与硬膜外麻醉复合丙泊酚靶控输注全麻组(PE组,n=30)o记录麻醉前(T0)、术毕(T1)、术后6h(T2),24h(T3),48h(T4)的血压、心率,并检测血清CK、CKMB、乳酸脱氢酶(LDH)、谷草转氨酶(
2、AST)及心肌肌钙蛋白I(cTnI)的变化。结果与T0比较,PE组各时点血压显著降低;P组舒张压显著增高,T1〜T4时点显著高于PE组(P0.05或0.01)。与T0比较,两组T1〜T4时CK均显著增高,T3、T4吋P组显著高于PE组(P0.05或0.01)。丁2时?组(313、显著増高(P0.05或0.01),PE组T1时显著降低(P0.05),Tl、T3吋P组cTnI显著高于PE组(P0.05或0.01)。结论与全麻比较,硬膜外麻醉复合全麻用于老年高血压患者非心脏手术时更能够减少围手术期心肌的损害。【关键词】高血压;麻醉,全身;麻醉,硬膜外;心肌;肌酸激酶;同工酶类;肌钙蛋白IABSTRACT:ObjectiveToinvestigatetheeffectsofgeneralanesthesiaandepiduralanesthesiacombinedwithgeneralanesthesiaonperio4、perativecreatinekinase(CK)andMBisoenzymeofcreatinekinase(CKMB)inelderlypatientswithhypertension.MethodsFortyASAIIorIIIelderlypatientsundergoingelectiveabdominalsurgerywererandomlydividedintotwogroups(n=30each):GroupP,receivingpropofoltargetcontrolledinfusion(TCI)andGroup5、PE,receivingcombinedpropofolTCIwithepiduralanesthesia.Bloodpressure,heartrate,serumCK,CKMB,LDH,ASTandcTnIwererecordedbeforeanesthesia.TOcardiacdrugsusagesandVASscoresat6,24,48hoursafteroperationwererecorded.ResultsPostoperativebloodpressureinGroupPEwassignificantlydecrea6、sed.DiastolicpressureinGroupP,attheendofanesthesia(T1),andat6h(T2),24h(T3),48h(T4)afteroperation,increasedsignificantlywhencomparedwiththatofTO.PostoperativebloodpressureinGroupPwassignificantlyhigherthaninGroupPE.VASscoresandtheusageofcardiacdrugsinGroupPweremarkedlylow7、erthanthoseofGroupPE.CK,CKMB,LDHandASTwerealsochangedinbothgroups.CTnIinGroupPincreasedsignificantlyafteroperationwhencomparedwiththatofTO.CTnIinGroupPEdecreasedsignificantlyatT1andwassignificantlylowerthanthatofGroupPatT1andT3.ConclusionEpiduralanesthesiacombinedwithgen8、eralanesthesiainelderlypatientswithhypertensionhasabetterprotectiveeffectonmyocardialinjurycomparedwith
3、显著増高(P0.05或0.01),PE组T1时显著降低(P0.05),Tl、T3吋P组cTnI显著高于PE组(P0.05或0.01)。结论与全麻比较,硬膜外麻醉复合全麻用于老年高血压患者非心脏手术时更能够减少围手术期心肌的损害。【关键词】高血压;麻醉,全身;麻醉,硬膜外;心肌;肌酸激酶;同工酶类;肌钙蛋白IABSTRACT:ObjectiveToinvestigatetheeffectsofgeneralanesthesiaandepiduralanesthesiacombinedwithgeneralanesthesiaonperio
4、perativecreatinekinase(CK)andMBisoenzymeofcreatinekinase(CKMB)inelderlypatientswithhypertension.MethodsFortyASAIIorIIIelderlypatientsundergoingelectiveabdominalsurgerywererandomlydividedintotwogroups(n=30each):GroupP,receivingpropofoltargetcontrolledinfusion(TCI)andGroup
5、PE,receivingcombinedpropofolTCIwithepiduralanesthesia.Bloodpressure,heartrate,serumCK,CKMB,LDH,ASTandcTnIwererecordedbeforeanesthesia.TOcardiacdrugsusagesandVASscoresat6,24,48hoursafteroperationwererecorded.ResultsPostoperativebloodpressureinGroupPEwassignificantlydecrea
6、sed.DiastolicpressureinGroupP,attheendofanesthesia(T1),andat6h(T2),24h(T3),48h(T4)afteroperation,increasedsignificantlywhencomparedwiththatofTO.PostoperativebloodpressureinGroupPwassignificantlyhigherthaninGroupPE.VASscoresandtheusageofcardiacdrugsinGroupPweremarkedlylow
7、erthanthoseofGroupPE.CK,CKMB,LDHandASTwerealsochangedinbothgroups.CTnIinGroupPincreasedsignificantlyafteroperationwhencomparedwiththatofTO.CTnIinGroupPEdecreasedsignificantlyatT1andwassignificantlylowerthanthatofGroupPatT1andT3.ConclusionEpiduralanesthesiacombinedwithgen
8、eralanesthesiainelderlypatientswithhypertensionhasabetterprotectiveeffectonmyocardialinjurycomparedwith
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