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目的 观察心血管迷走反射在老年患者冠状动脉介入治疗及射频消融治疗拔除动脉鞘后的发生率 ,并探讨其预防措施。方法 712例介入治疗患者 :冠脉介入治疗 (PTCA +STENT) 5 30例 ,经动脉逆行射频消融 182例。按年龄 (≥ 6 5岁 )分为老年组 (316例 )和普通组 (396例 ) ,所有患者拔管前快速输注生理盐水10 0 2 0 0ml/小时 ,应用 3 4小时。拔管时先局部应用 1%利多卡因于鞘管旁浸润麻醉。观察两组心血管迷走反射发生率。结果 老年组拔管时迷走反射发生率 (12 / 316 ,3.79% )明显高于普通组 (5 / 396 ,1.2 6 % ) ,具有显著性差异 ,P <0 .0 5。结论 介入治疗后拔管引起心血管迷走反射系局部按压血管牵张反射、疼痛、紧张、术前禁食水容量减少及血管床容积突然增大等原因所致 ,在老年患者中发生率明显升高 ,可能因为老年人对疼痛耐受性差 ,自主神经调节能力降低 ,较年轻人更易紧张所致。术前教育 ,解除患者顾虑 ,拔管时密切监测 ,补充足够液体 ,良好麻醉是减少拔管反应的关键。
Objective To observe the incidence of cardiovascular vagal reflex after coronary artery interventional therapy and radiofrequency catheter ablation in elder patients and explore the preventive measures. Methods One hundred and seventy-two patients with interventional therapy were enrolled in this study: 535 patients underwent coronary intervention (PTCA + STENT) and 182 patients underwent retrograde radiofrequency ablation. The patients were divided into the elderly group (316 cases) and the general group (396 cases) according to their age (≥65 years old). All patients were infused with 10 000 ml / h normal saline immediately before extubation for 34 hours. Extubation first local application of 1% lidocaine intrathecal infiltration anesthesia. The incidence of cardiovascular vagal reflexes was observed. Results The incidence of vagal reflex (12/316, 3.79%) in the elderly group during extubation was significantly higher than that in the normal group (5/396, 1.2 6%), with significant difference (P <0.05). Conclusions Extubation may cause cardiovascular distraction and reflex partial pressure vascular distraction, pain, stress, decreased preoperative fasting water volume and sudden increase of vascular bed volume after interventional therapy, and the incidence is significantly higher in elderly patients High, may be due to poor tolerance to pain in the elderly, reduced autonomic regulation, more easily than younger people nervous. Preoperative education to relieve patient concerns, careful monitoring during extubation, adequate fluid supplementation, and good anesthesia are the key to reducing extubation response.