Effect of different anesthesia methods on perioperative volume load of lower limb joint replacement in patients with coronary heart disease / 中国医师进修杂志

ABSTRACT

Objective@#To compare the effects of general anesthesia, intraspinal anesthesia combined with general anesthesia and lumbar plexus block combined with general anesthesia on the volume load of lower limb joint replacement surgery in patients with coronary heart disease.@*Methods@#One hundred and twenty patients (ASA classification Ⅱ-Ⅲ) with coronary heart disease who underwent selective lower extremity arthroplasty in Hubei Aerospace Hospital from January 2017 to November 2018 were randomly divided into three groups general anesthesia group (group A), spinal canal combined with superficial general anesthesia group (group B) and lumbar plexus nerve block combined with superficial general anesthesia group (group C), with 40 cases in each group. The mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), stroke volume index (SVI) and stroke volume variation (SVV) were observed and recorded at the time of entering operation room (T0), immediate induction of anesthesia(T1), immediately after the operation (T2), 1 h after surgery (T3) and at the end of the operation (T4) in three groups. The operation time, anesthesia time and the incidence of complications of the three groups were recorded.@*Results@#At T1, HR, MAP, CI and SVV of the three groups were lower than T0, and SVV were higher than T0, and there were significant differences (P < 0.05). At T1 and T2, the MAP, CI and SVI in group B were significantly lower than those in group A and group C[T1 (76.8 ± 5.4) mmHg (1 mmHg=0.133 kPa)vs. (84.4 ± 14.9) and (86.4 ± 19.1) mmHg, (1.9 ± 0.6) L/(min·m2) vs. (2.5 ± 0.7) and (2.3 ± 0.5) L/(min·m2), (35.5 ± 11.5) ml/m2 vs.(40.5 ± 11.8) and (39.2 ± 10.3) ml/m2; T2 (74.6 ± 6.7) mmHg vs. (89.9 ± 17.8) and (82.8 ± 19.7) mmHg, (2.6 ± 0.7) L/(min·m2) vs. (2.8 ± 0.7) and (2.6 ± 0.4) L/(min·m2), (38.2 ± 13.7) ml/m2 vs. (44.9 ± 7.9) and (45.8 ± 8.3) ml/m2], and at T1, the SVV of group B was significantly higher [(15.6 ± 2.1)% vs. (13.8 ± 4.3)% and (13.9 ± 2.9)%], and there were significant differences (P < 0.05). At T2-T4, the HR and MAP of group A were significantly higher than those of the other two groups (P < 0.05). The incidence of hypertension, hypotension and unstable angina pectoris in group C was significantly lower than that in group A and group B [5.0%(2/40) vs. 20.0%(8/40) and 35.0%(14/80)](P < 0.05).@*Conclusions@#Lumbar plexus block combined with shallow general anesthesia is safer for patients with coronary heart disease because of its smaller fluctuation of volume load index, more stable hemodynamics and lower incidence of cardiovascular adverse events.