Clinical study on optimized anesthesia method in elderly patients with coronary heart disease scheduled for undergoing lower extremity surgery / 中华老年医学杂志

ABSTRACT

Objective To evaluate the safety and efficacy of three types of anesthesia methods in elderly patients with coronary heart disease undergoing unilateral lower extremity surgery.Methods Totally 65 patients with coronary heart disease of cardiac function Ⅰ-Ⅱ (NYHA),scheduled for undergoing unilateral lower limb surgery were randomly divided into three groupslocal nerve block anesthesia of lumbar plexus plus the sciatic nerve (21 cases),general anesthesia (19 cases),epidural anesthesia (25 cases).Systolic blood pressure (SBP),heart rate (HR),pulse rate and blood oxygen saturation (SPO2) at 0 min,10 min,20 min,30 min,40 min after surgery at the end of the surgery were observed and recorded.The change of troponin Ⅰ (cTnI) at 3 day after surgery was observed.Visual analoguc scales (VAS) scores.movement reaction,the infortnation of muscle relax and corresponding management were recorded in order to detect anesthesia efficacy.Results The excellent and satisfactory rate of anesthesia efficacy of three groups were 17 cases (81.0％) and 4 cases (19.0％),17 eases (89.5％) and 2 cases (10.5％),22 cases (88.0％) and 3 cases (12.0％) (all P＞0.05).In epiduralgroup compared with other groups,SBP were decreased (both P＜0.05).cTnI in nerve stimulator group was decreased (all P＜0.05) at 1 and 3 day after surgery compared with general anesthesia group,and at 3 day after surgery,cTnI level in nerve stimulator group was lower than other two groups(all P＜0.05).Conclusions The nerve stimulator guided nerve block is the most safe method among general anesthesia and epidural anesthesia in elderly patients with coronary heart disease scheduled for lower extremity surgery.