冠状动脉支架术后患者行下肢手术采用外周神经阻滞麻醉临床观察.docVIP

冠状动脉支架术后患者行下肢手术采用外周神经阻滞麻醉临床观察 　【摘要】 [目的]观察PTCA术后患者行下肢手术，采用外周神经阻滞麻醉，血液动力学变化和心肌缺血情况及其临床意义。[方法]32例PTCA术后拟行下肢手术患者，施行腰丛联合坐骨神经阻滞麻醉，观察麻醉前即刻、切皮时、术中30min和术毕即刻收缩压(SP)、舒张压(DP)、心率(HR)变化，监测术前日24h、术中2～5h、术后48h动态心电图心肌缺血变化。[结果]切皮时、术中30min和术毕即刻的SP、DP、HR，较麻醉前即刻降低，差异显著有统计学意义;术中及术后平均每小时心肌缺血发作次数较术前明显增多，差异显著。[结论]外周神经阻滞麻醉对血液动力学影响小，可有效减少心血管不良事件的发生。 【关键词】 外周神经阻滞;冠状动脉支架;下肢手术;心肌缺血 　　Abstract：[Purpose]To study the changes of hemodynamic response and the states of myocardial ischemia with peripheral nerve block in patients with coronary heart disease after introcoronary stent(ICS)undergoing lowerextremity surgery in order to guide the clinical application.[Methods]Peripheral nerve block was performed on 32 patients with coronary heart disease after ICS undergoing lowerextremity surgery，the SP，DP and HR were measured before anesthesia，at the beginning of incision，30 min after the incision of surgery and after completion of operation;the states of myocardial ischemia reflected by DCG were monitored before 24h of surgery，2～5h after the incision and 48h after completion of operation.[Results]The SP，DP and HR were decreased more significantly at the beginning of incision，30 min after the incision of surgery and after completion of operation than before anesthesia(Plt;0.05).There were no significant differences of ST maximum displacement(STm)and duration of myocardial ischemia between after the incision of surgery and after completion of operation(Pgt;0.05).The frequency of occurences of myocardial ischemia during and after the surgery was increased significantly(Plt;0.05).[Conclusion]Peripheral nerve block is a good choice for patients with coronary heart disease after ICS undergoing lowerextremity surgery,which exerts a little influence for hemodynamic response and myocardial ischemia. 　　Key words：peripheral nerve block;introcoronary stent;lowerextremity surgery;myocardial ischemia 　　1 资料与方法 　　1.1 一般资料 我院自2008年8月至2009年8月冠状动脉支架置入术后患者行下肢手术32例，男19例、女13例，年龄59～82岁，体重43～88kg;行冠状动脉支架术后10～47个月不等，长期服用阿