在脆弱的老年人关节骨折患者的骨折脊柱麻醉和全身血动力学
Fredrik Olsen1, Mathias Hård Af Segerstad1, Keti Dalla1
1Anesthesia and Critical Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
F1000Research
|July 27, 2023
概括
老年患者的骨折脊髓麻醉导致血压中度下降,主要是由于静脉扩张导致心脏输出量减少,而不是血管阻力下降.
科学领域:
- 麻醉学 麻醉学
- 老年医学 老年医学
- 心血管生理学心血管生理学
背景情况:
- 在老年人,脆弱的患者中,内麻醉的全身血液动力学效应还未得到充分研究.
- 研究了使用局部麻醉剂和阿片类药物的微剂量进行部分脊髓麻醉.
研究的目的:
- 在接受关节骨折修复的老年患者中,检查部分脊髓麻醉的全身血动力学.
- 评估间歇性微剂量布皮瓦卡因和芬太尼对心血管参数的影响.
主要方法:
- 15名患有并发症的老年患者 (>65岁) 通过导管接受了脊髓麻醉.
- 心脏输出监测 (LiDCOplus) 追踪了平均动脉压 (MAP),心脏指数 (CI),全身血管阻力指数 (SVRI),心率和中风体积指数 (SVI).
- 两剂bupivacaine (2.25mg) 和fentanyl (15μg) 在25分钟的时间间隔内被给予.
主要成果:
- 30%的患者经历了低血压 (MAP下降>30%或MAP<65 mmHg),接受了北上腺素治疗.
- 在第一剂后,MAP降低了最多17%;CI,SVRI和SVI分别降低了10%,6%和7%.
- 心率保持不变,第二剂后没有显著的血液动力学变化.
结论:
- 分数脊柱麻醉在老年患者中会导致MAP的轻微到中度下降.
- 低血压的主要原因是由于全身静脉扩张和静脉回流减少,心脏输出量减少.
- 这一发现挑战了人们普遍认为,在这种情况下,降低系统性血管抵抗是低血压的主要驱动因素.
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