EFFECTS OF PERIOPERATIVE APNEIC EPISODES ON ARTERIAL OXYGEN SATURATION AND HEMODYNAMICS IN GERIATRIC PATIENTS

研究对象为在区域麻醉下接受择期下腹部或下肢手术的患者。对照组为65岁以下的老年人，在局麻下施行类似的手术。在研究期间测量空气流量、胸部运动、经皮血氧饱和度、心率和血压。对照组患者年龄在65岁以下或年龄等于或等于65岁以上，在腰麻下发生罕见的呼吸暂停发作。腰麻下老年患者在咪达唑仑剂量为0.014±0.022 mg/kg(0.5~1.5 mg)后90min内出现频发的阻塞性呼吸暂停。这些呼吸暂停发作与低氧血症有关。半数患者的氧合饱和度最低，低于90%。这些呼吸暂停和低氧发作与血流动力学改变无关。对照组患者年龄在65岁以下或年龄等于或大于65岁时，罕见的呼吸暂停EP…发作硬膜外麻醉下异丙肾上腺素增多。2 mg/Kg/HR异丙酚静注硬膜外麻醉的成人患者无阻塞性呼吸暂停。然而，老年患者(平均年龄74.1岁)在硬膜外麻醉下，以相同的比例输入异丙酚，发生与氧减饱和相关的阻塞性呼吸暂停的频率更高。三分之一的患者氧合饱和度最低，低于90%。这些呼吸暂停和缺氧发作与减饱和度无关。三分之一的患者氧合饱和度最低，低于90%。这些呼吸暂停和低氧事件与血流动力学改变无关。阻塞性呼吸暂停和氧减饱和度可通过持续正压气道压力得到缓解。结论：无论是腰麻还是硬膜外麻醉，T10水平以下的老年患者对小剂量咪达唑仑或异丙酚的呼吸抑制作用非常敏感。血流动力学改变不是区域麻醉下低氧血症的良好指标。这些镇静剂对气道阻塞和氧饱和度均有一定的影响。较少

PATIENTS UNDERGOING ELECTIVE LOWER ABDOMINAL OR LOWER EXTREMITY SURGERY UNDER REGIONAL ANESTHESIA STUDIED. CONTROL GROUP WAS CONSTITUED OF ADULATS AGE BELOW 65 YEARS OLD UNDERGOING THE SIMILAR SURGERY UNDER REGIONAL ANESTHESIA. AIRFLOW, CHEST MOVEMENT, PERCUTANEOUS OXYGEN SATURATION, HEART RATE, AND BLOOD PRESSURE WERE MEASURED DURING STUDY PERIOD.CONTROL GROUP PATIENTS EITHER AGE BELOW 65 OR AGE EQUAL TO OR AGE OVER 65 HAD RARE EPISODES OF APNEIC EPISODES UNDER SPINAL ANESTHESIA. GERIATRIC PATIENTS (MEAN AGE OF 74.6 YEARS OLD) UNDER SPINAL ANESTHESIA HAD FREQUENT EPISODES OF OBSTRUCTIVE APNEA WITHIN 90 MINUTES AFTER ONLY 0.014±0.022 MG/KG (RANGE 0.5-1.5 MG) OF MIDAZOLAM. THESE APNEIC EPISODES WERE ASSOCIATED WITH HYPOXEMIA. HALF OF THE PATIENTS HAD THE LOWEST OXYGYEN SATURATION BELOW 90%. THESE APNEIC AND HYOXIC EPISODES WERE NOT ASSOCIATED WITH HEMODYNAMIC CHANGES.CONTROL PATIENTS CONTROL GROUP PATIENTS EITHER AGE BELOW 65 OR AGE EQUAL TO OR AGE OVER 65 HAD RARE EPISODES OF APNEIC EP … More ISODES UNDER EPIDURAL ANESYHESIA. ADULT PATIENTS UNDER EPIDURAL ANESTHSIA SEDATED WITH PROPOFOL INFUSION AT 2 MG/KG/HR HAD NO EPISODES OF OBSTRUCTIVE APNEA. HOWEVER, GERIATRIC PATIENTS (MEAN AGE OF 74.1 YEARS OLD) UNDER EPIDURAL ANESTHESA SEDATED WITH PROPOFOL INFUTION AT THE SAME RATE HAD MORE FREQUENT EPISODES OF OBSTRUCTIVE APNEA ASSOCIATED WITH OXYGEN DESATURATION. ONE-THIRD OF THE PATINS HAD THE LOWEST OXYGYEN SATURATION BELOW 90%. THESE APNEIC AND HYOXIC EPISODES WERE NOT ASSOCIATED DESATURATION. ONE-THIRD OF THE PATINES HAD THE LOWEST OXYGYEN SATURATION BELOW 90%. THESE APNEIC AND HYOXIC EPISODES WERE NOT ASSOCIATED WITH HEMODYNAMIC CHANGES.THE OBSTRUCTIVE APNEA AND OXYGEN DESATURATION WAS AMELIOIATED BY CONTINUOUS POSITIVE AIRWAY PRESSURE.IN CONCLUSION, GERIATRIC PATIENS UNDER EITHER SPINAL OR EPIDURAL ANESTHESIA UP TO T10 LEVEL WERE VERY SENSIYIVE TO RESPIRATORY DEPRESSANT EFFECTS OF LOW DOSE MIDAZOLAM OR PORPOFOL INFUSION. HEMODYNAMIC CHANGES WERE NOT A GOOD INDICATOR OF HYPOXEMIA UNDER REGIONAL ANESTHESIA. POSITIVE AIRWAY PRESSURE WAS EFFECTVE TO AIRWAY OBSTRUCTION AND OXYGEN SATURATIN WITH THESE SEDATIVE AGENTS. Less