老年患者麻醉方式、麻醉药物与循环稳定性的研究综述

Bing Lu
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摘要

随着老年人口在社会中所占比例的增加,中国正逐步进入老龄化社会。老年患者在医疗过程中可能需要麻醉,考虑到老年患者手术风险较高,对麻醉的选择和麻醉药物的使用必须综合考虑。全麻诱导是患者在短时间内由生理状态向可手术麻醉状态进行可逆药物抑制的过程,但气管插管和麻醉抑制可引发心血管反应,特别是循环功能较差的老年患者,可导致血流动力学波动,影响循环功能的稳定性。随着老年患者年龄的增长,器官功能下降,麻醉应激下的储备功能不足可增加心血管不良事件的发生风险。全麻诱导期患者血流动力学波动较大,降低血流动力学波动,保持循环功能稳定对提高手术安全性至关重要。目前,全麻诱导常用的方法有手动静脉推注、靶控输注和输液泵恒速输注,全麻诱导常用的药物有静脉镇静麻醉剂、静脉镇痛药、肌肉松弛剂和吸入麻醉剂。本文基于对全麻、硬膜外麻醉、腰麻、硬膜外麻醉在老年患者手术中的应用效果及全麻诱导对老年患者循环稳定性的影响进行综述,以期更准确、更好地指导进一步的临床麻醉研究。
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A Collection of Studies on Anesthesia Modalities, Anesthetic Drugs and Circulatory Stability in Elderly Patients
With the increase in the proportion of elderly population in the society, China is gradually entering an aging society. Elderly patients may require anesthesia during medical treatment, and considering the relatively high surgical risk of elderly patients, comprehensive consideration must be given to the selection of anesthesia and the use of anesthetic drugs. Induction of general anesthesia is a process in which patients undergo reversible drug inhibition from a physiological state to a surgically operable anesthesia state within a short period of time, but tracheal intubation and anesthesia inhibition can trigger cardiovascular reactions, especially in elderly patients with poor circulatory function, which can lead to hemodynamic fluctuations and affect the stability of circulatory function. As elderly patients age, their organ function decreases, and their reserve function deficiency under anesthetic stress can increase the risk of adverse cardiovascular events. The hemodynamic fluctuations of patients during the induction period of general anesthesia are large, and it is important to reduce the hemodynamic fluctuations and maintain the stability of circulatory function to improve the safety of surgery. At present, the commonly used methods for induction of general anesthesia include manual intravenous push, target-controlled infusion and constant-rate infusion by infusion pump, and the commonly used drugs for induction of general anesthesia include intravenous sedative anesthetics, intravenous analgesics, muscle relaxants and inhaled anesthetics. Based on this paper, we analyze the effects of general anesthesia, epidural anesthesia, lumbar anesthesia, and epidural anesthesia in the application of surgery in elderly patients and general anesthesia induction in the circulatory stability of elderly patients for a review, in order to more accurately and better guide further clinical anesthesia research.
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