CAJ | 학술논문

目的观察经Spinocath导管行连续腰麻(continuous spinal anesthesia,CSA)用于老年患者行髋关节置换术时对血流动力学变化的影响. 方法 60例髋关节置换术老年患者,年龄65岁～95岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,完全随机设计分组方法分为观察组(CSA组)和腰硬联合(combined spinal-epidural anesthesia,CSEA)对照组(CSEA组),每组30例.两组均选择L2-3间隙穿刺,CSA组负荷剂量为0.75％罗哌卡因0.5 ml～1.0 ml,CSEA组注入0.75％罗哌卡因1.0 ml～2.0 ml,CSEA组硬膜外头向置管3 cm～4 cm,CSA组蛛网膜下腔置入Spinocath导管2 cm～3 cm,两组均采用Bioz.com数字化无创血流动力监测系统(impedance cardiogram,ICG)观察记录两组麻醉前和麻醉后5、10、15、30 min、1h及术毕的心排血量(cardiac output,CO)、平均动脉压(mean artery perssure,MAP)、外周血管阻力(systemic vascular resistance,SVR)、心脏加速度指数(acceleration index,ACI)以及胸腔液体量(thoracic fluid content,TFC)等,记录两组麻醉效果及副作用. 结果阻滞平面达T10时CSA组局麻药用量(1.1 ml)明显少于CSEA组(1.7 ml) (P＜0.05);CSEA组阻滞平面达T10时间(5.6 min)明显短于CSA组(9.6 min) (P＜0.05);CSEA组达最高阻滞平面的时间(14.7 min)和下肢运动完全阻滞的时间(5.1 min)也明显短于CSA组(18.4、9.8 min)(P＜0.05);两组在麻醉后5、10、20 min血流动力学指标差异有统计学意义(P＜O.05);CSA组麻黄素应用(2例)显著少于CSEA组(P＜0.01). 结论 CSA与CSEA麻醉比较,局麻药用量小,血流动力学稳定,麻醉效果可靠,尤适用于老年髋关节手术.
목적 관찰경Spinocath도관행련속요마(continuous spinal anesthesia,CSA)용우노년환자행관관절치환술시대혈류동역학변화적영향. 방법 60례관관절치환술노년환자,년령65세～95세,미국마취의사협회(ASA)분급Ⅰ～Ⅲ급,완전수궤설계분조방법분위관찰조(CSA조)화요경연합(combined spinal-epidural anesthesia,CSEA)대조조(CSEA조),매조30례.량조균선택L2-3간극천자,CSA조부하제량위0.75％라고잡인0.5 ml～1.0 ml,CSEA조주입0.75％라고잡인1.0 ml～2.0 ml,CSEA조경막외두향치관3 cm～4 cm,CSA조주망막하강치입Spinocath도관2 cm～3 cm,량조균채용Bioz.com수자화무창혈류동력감측계통(impedance cardiogram,ICG)관찰기록량조마취전화마취후5、10、15、30 min、1h급술필적심배혈량(cardiac output,CO)、평균동맥압(mean artery perssure,MAP)、외주혈관조력(systemic vascular resistance,SVR)、심장가속도지수(acceleration index,ACI)이급흉강액체량(thoracic fluid content,TFC)등,기록량조마취효과급부작용. 결과 조체평면체T10시CSA조국마약용량(1.1 ml)명현소우CSEA조(1.7 ml) (P＜0.05);CSEA조조체평면체T10시간(5.6 min)명현단우CSA조(9.6 min) (P＜0.05);CSEA조체최고조체평면적시간(14.7 min)화하지운동완전조체적시간(5.1 min)야명현단우CSA조(18.4、9.8 min)(P＜0.05);량조재마취후5、10、20 min혈류동역학지표차이유통계학의의(P＜O.05);CSA조마황소응용(2례)현저소우CSEA조(P＜0.01). 결론 CSA여CSEA마취비교,국마약용량소,혈류동역학은정,마취효과가고,우괄용우노년관관절수술.
Objective To compare the anesthesic effect and hemodynamic changes between the continuous spinal anesthesia (CSA) and combined spinal-epidural anesthesia (CSEA) with ropivacaine in patients for hip joint surgery.Methods Sixty ASA class Ⅰ-Ⅲ patients aged 65 to 95 years,undergoing hip joint operation including replacements of total hip and artificial thigh bone were randomly divided into CSA group and CSEA group (n =30).Spinal anesthesia was performed at L2-3 interspace.An initial subarachnoid bolus of 0.75％ hyperbaric ropivacaine 0.5 ml-l.0 ml was injected in the CSA group,if analgesia did not reach T10,supplemental ropivacaine was injected by titrating incremental doses.In the CSEA group,0.75％ hyperbaric ropivacaine 1 ml-2 ml was injected to the subarachnoid space at L2-3,and then a catheter was inserted into the epidual space for anesthesia maintenanc.The levels and times of sensory and motor block were measured and analysed.cardiac output (CO),mean artery perssure (MAP),systemic vascular resistance (SVR),acceleration index (ACI) and thoracic fluid content (TFC) were recorded with noninvasive h emodynamics monitor.Results The anesthetic dosage of the CSA group (1.1 ml) was smaller than that of the CSEA group (1.7 ml) (P＜0.05).The times of sensory block to T10 (5.6 min) or the maximal level (14.7 min) and motor block (5.1 min) were more rapid in the CSEA group than those of the CSA group (9.6,18.4,9.8 min)(P＜0.05).There were no significantly difference of MAP in the CSA group after anesthesia.There were all significantly differences in 5,l0 min and 20 min after anesthesia between the two groups (P＜0.05,P＜0.01).The dosage of ephedrine in the CSA group was significantly fewer than that in the CSEA group (P＜0.01).Conclusions Compared to CSEA,CSA is a safe technique of spinal anesthesia with small anesthetic dosages,more reliable and hemodynamically stable and more controllability in patients for hip joint operation.