CAJ | 학술논문

目的观察腰麻-硬膜外联合麻醉对老年患者血液动力学的影响.方法选择60例65岁及以上ASA Ⅱ～Ⅲ级,择期行单侧下肢全膝关节置换术的患者,随机分成腰麻-硬膜外联合麻醉组和连续硬膜外麻醉组,每组30例.记录患者一般情况,手术时间,术中出血量,液体输入量.观察腰麻或硬膜外给药前、给药后15 min和术毕时的MAP及HR.记录感觉阻滞平面和改良Bromage运动分级.观察需要给与麻黄碱或阿托品的病例数,以及出现止血带疼痛的人数.结果 2组患者一般情况、手术时间、术中出血量、液体输入量无差异,感觉阻滞平面无明显差异,运动阻滞程度有显著差异.各个时间点的MAP及HR无显著性差异.2组给予麻黄碱和阿托品的例数无显著性差异.2组出现止血带疼痛的例数相比有显著行差异.结论对行全膝关节置换术的老年患者实施腰麻-硬膜外联合麻醉,引起的血液动力学改变与硬膜外麻醉相比无明显差异,且患者止血带反应较轻.
목적 관찰요마-경막외연합마취대노년환자혈액동역학적영향.방법 선택60례65세급이상ASA Ⅱ～Ⅲ급,택기행단측하지전슬관절치환술적환자,수궤분성요마-경막외연합마취조화련속경막외마취조,매조30례.기록환자일반정황,수술시간,술중출혈량,액체수입량.관찰요마혹경막외급약전、급약후15 min화술필시적MAP급HR.기록감각조체평면화개량Bromage운동분급.관찰수요급여마황감혹아탁품적병례수,이급출현지혈대동통적인수.결과 2조환자일반정황、수술시간、술중출혈량、액체수입량무차이,감각조체평면무명현차이,운동조체정도유현저차이.각개시간점적MAP급HR무현저성차이.2조급여마황감화아탁품적례수무현저성차이.2조출현지혈대동통적례수상비유현저행차이.결론 대행전슬관절치환술적노년환자실시요마-경막외연합마취,인기적혈액동역학개변여경막외마취상비무명현차이,차환자지혈대반응교경.
Objective To approach the hemodynamic effects of combined spinal-epidural anesthesia in 65 years or older patients. Methods In a prospective study, 60 American Society of Anesthesiologists Ⅱ～Ⅲ patients (aged 65 yr or older), undergoing elective TKR surgery were randomLy assigned to either CSE an-esthesia (CSEA, n=30) or epidurai anesthesia alone (CEA, n=30). The age, sex, duration of surgery, blood loss, fluid infusion during the surgery and main complications were recorded. Hemodynamic measure-ments included invasive or non-invasive mean arterial blood pressure (MAP), heart rate (HR) before an-aesthesiaufe, 15 wins after anaesthesia and the end of surgery. Our primary endpoint (outcome) was the number of hypotension and bradycardic episodes (defined as MAP<70 mmHg and HR<50 beats per mi-nute). Cases of blood bandage were also recorded. Results There was no significant difference between two groups in the age, sex, duration of surgery, blood loss, fluid infusion and main complications. Using univariate analysis, we found no significant differences between the groups in regards to MAP, HR during the perioperative period. The incidence of hypotension was similar in both groups (7 patients in CSEA and 6 in CEA group, P=0.704), as of bradycardia (3 patients in CSE, 5 in epidural, P=0.754). The inci-dance of blood bandage pain of CSE group was higher than CSEA group. Conclusion Combined spinal-epi-dural anesthesia and epidural anesthesia alone during TKB surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.