CAJ | 학술논문

目的观察单侧脊麻-硬膜外联合麻醉用于高龄患者髋部手术的麻醉效果和安全性.方法选择150例拟髋部手术高龄患者,年龄75～101岁,随机分成三组:持续硬膜外麻醉组(CEA组)、脊麻-硬膜外联合麻醉组(CSEA组)和单侧脊麻复合硬膜外麻醉组(OCSEA组),每组50例.选择第2～3腰椎或第3～4腰椎椎间隙为穿刺点,CEA组单纯硬膜外腔给药,阻滞药为1.5%利多卡因或1%利多卡因与0.375%布比卡因混合液,首剂总量7～12 ml;CSEA组蛛网膜下腔给药后头向置入硬膜外导管3.5 cm备用后立即平卧,OCSEA组蛛网膜下腔给药及头向置入硬膜外导管后仍保持侧卧位10～15 min.麻醉平面尽可能控制在第10胸椎以下.CSEA组和OCSEA组脊麻用药均为0.5%布比卡因重比重液1.5～1.7 ml.比较三组的麻醉平面、麻醉效果及血压变化情况.结果 CSEA组和OCSEA组麻醉效果优于CEA组,CSEA组和OCSEA组的麻醉平面比CEA组更容易控制,OCSEA组的血压更为稳定,差异有统计学意义(P＜0.05).结论 0.5%布比卡因重比重液小剂量单侧脊麻复合硬膜外麻醉血压变化小,安全有效,较适合高龄患者髋部手术的麻醉.
목적 관찰단측척마-경막외연합마취용우고령환자관부수술적마취효과화안전성.방법 선택150례의관부수술고령환자,년령75～101세,수궤분성삼조:지속경막외마취조(CEA조)、척마-경막외연합마취조(CSEA조)화단측척마복합경막외마취조(OCSEA조),매조50례.선택제2～3요추혹제3～4요추추간극위천자점,CEA조단순경막외강급약,조체약위1.5%리다잡인혹1%리다잡인여0.375%포비잡인혼합액,수제총량7～12 ml;CSEA조주망막하강급약후두향치입경막외도관3.5 cm비용후립즉평와,OCSEA조주망막하강급약급두향치입경막외도관후잉보지측와위10～15 min.마취평면진가능공제재제10흉추이하.CSEA조화OCSEA조척마용약균위0.5%포비잡인중비중액1.5～1.7 ml.비교삼조적마취평면、마취효과급혈압변화정황.결과 CSEA조화OCSEA조마취효과우우CEA조,CSEA조화OCSEA조적마취평면비CEA조경용역공제,OCSEA조적혈압경위은정,차이유통계학의의(P＜0.05).결론 0.5%포비잡인중비중액소제량단측척마복합경막외마취혈압변화소,안전유효,교괄합고령환자관부수술적마취.
Objective To observe the effect and safety of unilateral spinal anesthesia-epidural anesthesia for elderly patients with hip surgery. Methods A total of 150 elderly patients scheduled for hip surgery, aged 75 to 101 years old, were randomly divided into three groups :continuous epidural anesthesia group (CEA group), spinal-epidural anesthesia group (CSEA group) and unilateral spinal anesthesia combined with epidural anesthesia group (OCSEA group), 50 cases in each group. Choosing L2-3 or L3-4 intervertebral space as the puncture site, CEA group were epidural administration, blockers of 1.5% lidocaine or 1% lidocaine with 0. 375% bupivacaine, the first agent volume 7-12 ml; CSEA group during the first administration to the subarachnoid epidural catheter was placed supine immediately after the backup 3.5 cm. OCSEA group subarachnoid administration and the first epidural catheter to maintain the lateral position after 10-15 min. Control of anesthesia as the following in T10. CSEA group and OCSEA spinal drug group were 0. 5% hyperbaric bupivacaine solution 1.5-1.7 ml. Comparing three groups of anesthesia, anesthesia and blood pressure changes. Results CSEA group and OCSEA anesthesia were better than the CEA group. The anesthetic plane of CSEA group and OCSEA group were easier to control than that of the CEA group. OCSEA group has more stable blood pressure(P＜0.05).Conclusions 0.5% solution of low dose hyperbaric bupivacaine spinal anesthesia combined with epidural anesthesia unilateral was vary in blood pressure. It is safe and effective, and more suitable for elderly patients with hip surgery anesthesia.