松止血带对血流动力学的影响.pdf
松止血带对血流动力学的影响.pdf
腓骨瓣切去术中最关注的问题 血流动力学稳定 酸碱平衡 The effec t of tour niqu et defla tion on hem ody nam 第四军医大口腔医院 荀泽敏 Background-basic Surgeries for aged patients are increasing consistently The aged with cardiopulmonary or cerebrovascular disease A pneumatic tourniquet minimize blood loss and secure a clean surgical Fielintensify the risk of complications like hypertension or hypotension, deep vein thrombosis, cerebral infarction, nerve injury and infection Background-blood pressure regulation Aged are more vulnerable to blood pressure regulation due to changes in autonomic nervous system and decrease in cardiac reserve Sudden blood pressure fluctuation can be fatal to the aged even leading to cardiac or brain ischemia Various accompanying diseases may endanger the aged during anesthesia and perioperative period Background-blood pressure regulation Inflation and deflation of a pneumatic tourniquet during surgery induces miscellaneous alterations in patient's hemodynamic and metabolic status Especially, reperfusion to the exsanguinated area and bleeding from the surgical area, following tourniquet deflation, gives rise to hypotension, arterial oxygen and carbon dioxide partial pressure modification, lactic acidemia, and hyperkalemia Background-cognitive dysfunction Cerebral hypoperfusion secondary to hypotension may bring about postoperative cognitive dysfunction in the aged Appropriate monitoring becomes critical in anesthesia Monitoring for the central nervous system is rare, making it difficult to find out neurologic adverse events during general anesthesia. Background-equipment Nearinfrared spectroscopy (NIRS) is a noninvasive, continuous monitoring device, designed to estimate the regional cerebral oxygen saturation (rSO2) by expressing the percentage between oxygenated and deoxygenated hemoglobin in the cerebral tissues NIRS reflects a balance among cerebral oxygen supply and demand Background-summary The aged lack compensatory mechanism to adjust to hemodynamic changes, following tourniquet deflation Active monitoring is essential We evaluated the effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in the aged Methods Obtaining approval from the Institutional Review Board Written informed consent Include:Twenty-eight ASA I or II patients, over the age of sixty-five years Excluded:Patients with a history of hypertension, stroke, heart failure or arrhythmia, chronic obstructive pulmonary disease, chronic kidney disease, and liver cirrhosis Methods No premedication was given Monitoring:3-lead electrocardiography, automatic noninvasive blood pressure peripheral pulse oximetry the regional cerebral oxygen saturation (rSO2) arterial blood pressure arterial blood gas analysis Record:MAP HR left and right rSO2, CO SV were Methods Induction: 3 min of pre-oxygenation 0.04 mg/kg of midazolam 0.2 mg of glycopyrrolate 4 mg/kg of thiopentalsodium 1 μg/kg of fentanyl the patient’s unconsciousness 0.6 mg/kg of rocuronium Methods Maintained: mixture of oxygen and nitrous oxide sevoflurane 1.0-2.0 vol%. VT:10 ml/kg RR:10/min EtCO2: 30-35 warming device Before skin incision, a pneumatic tourniquet applied to the ipsilateral thigh was inflated to 350 mmHg. Record:Arterial blood gas analysis was performed 5 min before, and in addition to 0, and 10 min after tourniquet deflation Methods Statistical analysis : SPSS: compare the baseline data with the data at each time point Linear regression analysis :determine the correlation between the maximal decrease of the mean arterial pressure and regionalcerebral oxygen saturation Methods ·%△MAPmax = [(baseline MAP - measured minimal MAP) /baseline MAP] × 100 ·%△rSO2max = [(baseline rSO2 - measured minimal rSO2) /baseline rSO2] × 100 A P value less than 0.05 was considered statistically significant Results Results Results Results Results Results Results Discussion Aged: functional disorders decreased response to beta receptor stimulation impaired conducting system Following tourniquet deflation: reperfusion to the exsanguinated bleeding CVP MAP CO decreases the cerebral ischemia based on the changes in rSO2 tourniquet deflation created significan themodynamic and metabolic changes in the aged 手术时间 血流动力学 止血带充气时间 止血带放气后时间 止血带充气次数 失血量 THANK YOU