CAJ | 학술논문

目的：探讨加强围手术期麻醉管理对老年腹腔镜手术患者术后并发症的影响，为临床麻醉管理措施的实施提供参考。方法选取接受腹腔镜手术的老年患者90例作为研究对象，采用随机数字表法分为观察组和对照组各45例。对照组按照围手术期麻醉管理的常规措施进行干预，观察组给予加强围手术期麻醉管理。比较两组患者手术前、气管插管时、切皮后、停药时的血压、心率变化情况；同时比较两组术后血压异常、寒颤、低氧血症、缺血性心脏病等并发症的发生率。结果两组术前和停药时收缩压、舒张压、心率差异均无统计学意义；观察组气管插管时收缩压为（136．92±19．57）mmHg，舒张压为（84．57±12．39）mmHg，切皮后收缩压为（126．93±16．68）mmHg，舒张压为（78．43±11．76）mmHg，均显著高于对照组，差异有统计学意义（t ＝4．56、4．98、5．14、5．83，均 P ＜0．05）；观察组气管插管时心率为（74．46±11．28）次／min，显著低于对照组，差异有统计学意义（t ＝5．25，P ＜0．05）；观察组术后血压异常8例，寒颤2例，低氧血症1例，术后并发症发生率24．44％，对照组术后血压异常15例，寒颤4例，低氧血症5例，缺血性心脏病2例，术后并发症的发生率为57．78％。观察组术后并发症发生率显著低于对照组（χ2＝14．58，P ＜0．05）。结论加强围手术期麻醉管理有助于减少老年腹腔镜患者围手术期的血压、心率的波动，降低术后并发症的发生率，提高麻醉的安全性。
목적：탐토가강위수술기마취관리대노년복강경수술환자술후병발증적영향，위림상마취관리조시적실시제공삼고。방법선취접수복강경수술적노년환자90례작위연구대상，채용수궤수자표법분위관찰조화대조조각45례。대조조안조위수술기마취관리적상규조시진행간예，관찰조급여가강위수술기마취관리。비교량조환자수술전、기관삽관시、절피후、정약시적혈압、심솔변화정황；동시비교량조술후혈압이상、한전、저양혈증、결혈성심장병등병발증적발생솔。결과량조술전화정약시수축압、서장압、심솔차이균무통계학의의；관찰조기관삽관시수축압위（136．92±19．57）mmHg，서장압위（84．57±12．39）mmHg，절피후수축압위（126．93±16．68）mmHg，서장압위（78．43±11．76）mmHg，균현저고우대조조，차이유통계학의의（t ＝4．56、4．98、5．14、5．83，균 P ＜0．05）；관찰조기관삽관시심솔위（74．46±11．28）차／min，현저저우대조조，차이유통계학의의（t ＝5．25，P ＜0．05）；관찰조술후혈압이상8례，한전2례，저양혈증1례，술후병발증발생솔24．44％，대조조술후혈압이상15례，한전4례，저양혈증5례，결혈성심장병2례，술후병발증적발생솔위57．78％。관찰조술후병발증발생솔현저저우대조조（χ2＝14．58，P ＜0．05）。결론가강위수술기마취관리유조우감소노년복강경환자위수술기적혈압、심솔적파동，강저술후병발증적발생솔，제고마취적안전성。
Objective To investigate the effect of perioperative anesthesia management on postoperative complications of laparoscopic operation for elderly patients,and to provide reference for the clinical anesthesia man-agement.Methods 90 elderly patients who received laparoscopic surgery were randomly divided into observation group and control group,45 cases in each group.The control group was treated with the routine intervention of the perioperative anesthesia management,and the observation group was given to strengthen the perioperative anesthesia management.The intubation,skin incision,withdrawal of blood pressure,heart rate changes before surgery,and abnor-mal blood pressure,chills,hypoxemia,ischemic heart disease,incidence of complications after surgery were compared between the two groups.Results Before surgery,the withdrawal of the systolic blood pressure,diastolic blood pres-sure,heart rate between the two groups had no statistically significant differences (P >0.05 ).In the observation group,during tracheal intubation for systolic blood pressure (136.92 ±19.57 )mmHg,diastolic blood pressure (84.57 ±12.39)mmHg,after skin incision systolic blood pressure (126.93 ±16.68)mmHg,diastolic blood pressure (78.43 ±11.76)mmHg,which were significantly higher than those in the control group (P <0.05).In the observa-tion group,during tracheal intubation the heart rate was (74.46 ±11.28)/min,which was significantly lower than the control group (P <0.05),abnormal blood pressure of the patients in the observation group was 8 cases,2 cases of shivering,hypoxemia in 1 case,the incidence rate of postoperative complications was 24.44%,abnormal blood pres-sure after surgery in the control group had 15 cases,4 cases of shivering,hypoxemia in 5 cases,ischemic heart disease 2 cases,the incidence rate of postoperative complications was 57.78%.The incidence of postoperative complications in the observation group was significantly lower than that of the control group (χ2 =14.58,P <0.05).Conclusion To strengthen the perioperative anesthesia management helps to reduce the blood pressure and heart rate fluctuations during perioperative period,and can reduce the incidence of postoperative complications and improve the safety of anesthesia.