【摘要】 目的:观察老年人硬膜外麻醉及给予麻醉辅助药后对心率变异性的影响。方法:选择ASA Ⅰ～Ⅱ级,年龄≥60岁的行腰段硬膜外麻醉的病人40例,硬膜外药液为1.6%利多卡因+0.2%丁卡因,给全量15min后静脉注入麻醉辅助药合剂。病例随机分4组,Ⅰ组:哌替啶1mg/kg+氯胺酮1mg/kgⅡ组:咪唑安定0.05mg/kg+氯胺酮1mg/kg Ⅲ组:异丙酚1mg/kg+氯胺酮1mg/kgⅣ组:异丙酚1mg/kg+芬太尼2μg/kg,记录入术室平卧15min、硬膜外麻醉给全量后5、10、15min及给予麻醉辅助药合剂观察OAA/S评分为5、3、1min各时间的收缩压(SBP)、舒张压(DBP)、脉搏血氧饱和度(SpO2)、心率(HR),以Hoter动态心电图仪,监测心率变异性(HRV)情况,分析指标为总功率(TP)、高频(HF)、低频(LF)及高频/低频(LF/HF)。结果:与基础值比较硬膜外给药后5、10min的TP降低,15min无显著差异。LF、HF、LF/HF未见显著改变。与清醒比较给予麻醉辅助药后Ⅰ组HF标准化值增高,LF/HF降低。Ⅱ、Ⅲ、Ⅳ组TP值均降低,Ⅱ、Ⅲ组HF、LF降低。给予静脉辅助药后各组血氧饱和度均有下降,以Ⅳ组最为显著。结论:①老年人腰段硬膜外麻醉下HRV有变化;②不同组成的麻醉辅助药合剂在镇静作用评分相同时对HRV影响不一致。更多还原

【Abstract】 Objective: To investigate the effect of epidural block and anesthesia adjuvant drug on heart rate variability in aged patients. Methods: Forty patients (ASA grade Ⅰ-Ⅱ ,aged ≥60 years) were given lumber epidural block (1. 6%lidocaine +0.2% dicaine) and 15 minutes after that infused anesthesia adjuvant drugs. Patients were randomly divided into four groups , group Ⅰ: Pethidine 1mg. kg-1 + ketamine 1mg. kg-1; group Ⅱ: midazolam 0. 05mg. kg-1+ketamine 1mg. kg-1; group Ⅲ: propofol 1mg. kg-1+ketamine 1mg. kg-1; group Ⅳ: propofol 1mg. kg-1+fentanyl 2μg. kg-1. SBP, DBP, SpO2, and HR in different time were recorded for 15min during their prostration in the operating room, in such an order as giving total dosage through epidural 5,10, and 15min and then giving anesthesia adjuvant for investigating 5, 3, and 1 point of OAA/S grade, and HRV was monitored with Hoter dynamic electrocardiogram instrument. Result: Compared with the foundation value, the TP lowered in 5 and 10min with no significant difference in 15min after epidural infusion. The LH, HF, and LF/HF showed no significant change. In the awake state, the HF increased and the LF/HF lowered in group Ⅰ, and the TP lowered in group Ⅱ, Ⅲ, Ⅳ, HF and LF lowered in group Ⅱ and Ⅲ, and the SpO2 in every group lowered and group Ⅳ showed the most significant changes after infusing adjuvant drugs. Conclusion : ①. There are changes in HRV in the aged patients under lumber epidural block ; ②. The effects of different adjuvant drugs on HRV were different in the same sedation grade.更多还原