摘要
目的：研究老年病人麻醉期间氧代谢变化，并分析其原因，提出保护老年病人麻醉期间氧供需平衡的方法。方法：选择上腹部手术老年病人(年龄>65岁)30例，按数字随机法分为全麻组(n=15)和硬膜外麻醉组(n=15)，并随机选择青壮年上腹部手术病人10例，作全麻对照组。监测麻醉期间老年病人氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)、混合静脉血氧饱和度(SVO2)和动脉血乳酸含量(ABL)等指标动态变化的情况。结果：老年病人全麻组与硬膜外麻醉组比较：前者麻醉诱导后至术毕DO2、VO2、ERO2 均小于后者,并且SVO2、ABL均大于后者,它们之间均有显著性差异或非常显著的统计学意义(P<0．05或P<0．01)。而老年全麻组与青壮年全麻对照组比较：前者DO2、VO2、ERO2小于后者，SVO2 、ABL大于后者，而且它们之间也有显著性差异(P<0．05)。结论：上腹部手术老年病人全麻期间存在氧供需平衡障碍，出现明显的组织缺氧。根本的原因可能是老年病人微循环障碍的存在，而硬膜外麻醉有改善老年病人微循环障碍，纠正氧供需平衡失调的作用。
To evaluate the changes of oxygen deliver y and consumption balance during geriatric anesthesia,and analyze the reasons a nd find out some ways to protect the balance of oxygen delivery and consumption Methods:Twenty patients,more than 65 years,ASA class Ⅰ or Ⅱ,und ergoing major abdominal surgery,we re randomly allocated to two groups(n=15)who were general anesthesia or epidural anesthesia,respectively,and the third group(n=10),less than 65 years,with major abdominal surgery,as general anesthesia control Within this three groups,the dynamic changes of oxygen delivery (DO2),oxygen consumption (VO2), oxygen extraction rate (ERO2),mixed venous oxygen saturation (SVO2), and arteral bloo d lactate (ABL),were monitored during anesthesiaResults:In geriatric general anesthesia group, from anesthesia induction to the end of operation, DO2,VO2 and ERO2 were decreased and SVO2、ABL increased significan tly compared with those in geriatric epidural anesthesia group(P<0.05,or P<0.01) or in general control group (P<0.05)Conclusions:Among geriatric patients undergoing major abdominal surgery during general anesthesia,oxygen supply demand balance is destroyed and tissue hypoxia occurs The basic reason for this may be the existence of disturbance of mi crocirculation, while epidural anesthesia can improve this disturbance, so epidu ral anesthesia is an effectice method to safeguard oxygen supply demand balance
