CAJ | 학술논문

　　目的探讨轻比重布比卡因腰硬联合麻醉在老年人高血压患者行下肢股骨头置换手术的麻醉效果及其对血流动力学影响。方法74例 ASA II～III 级同时合并有高血压65～88岁择期下肢手术患者分为两组，其中 A 组(收缩压≥180 mm Hg )，B 组(160 mm Hg ≤收缩压＜180 mm Hg )。采用0.5%布比卡因轻比重液腰硬联合麻醉。观察两组给药前及给药后3、5、10、15、20 min 的平均动脉压的变化，并同时观察两侧痛觉平面，术中不良反应及术后不良反应。结果A 组的血流动力学变化值明显大于 B 组。结论高龄高血压患者在行下肢骨科手术时，采用轻比重腰硬联合麻醉，术前应对高血压进行积极治疗，术中适当扩容可使麻醉过程更趋平稳，术后并发症会更少。
　　목적탐토경비중포비잡인요경연합마취재노년인고혈압환자행하지고골두치환수술적마취효과급기대혈류동역학영향。방법74례 ASA II～III 급동시합병유고혈압65～88세택기하지수술환자분위량조，기중 A 조(수축압≥180 mm Hg )，B 조(160 mm Hg ≤수축압＜180 mm Hg )。채용0.5%포비잡인경비중액요경연합마취。관찰량조급약전급급약후3、5、10、15、20 min 적평균동맥압적변화，병동시관찰량측통각평면，술중불량반응급술후불량반응。결과A 조적혈류동역학변화치명현대우 B 조。결론고령고혈압환자재행하지골과수술시，채용경비중요경연합마취，술전응대고혈압진행적겁치료，술중괄당확용가사마취과정경추평은，술후병발증회경소。
Objective To investigate the anesthetic effects of light specific gravity bupivacaine in combined spinal and epidural anesthesia for elderly patients with hypertension in femoral head replacement of lower limbs and its effects on the haemodynamics. Methods 74 patients with American Society of Anesthesiologists ( ASA ) grade II-III combined with hypertension underwent selective operations in lower limbs, whose age ranged from 65 to 88 years old. They were divided into 2 groups: group A ( systolic blood pressure ≥180 mm Hg ) and group B ( 160 mm Hg ≤ systolic blood pressure <180 mm Hg ). Light specific gravity bupivacaine ( 0.5% ) was used in combined spinal and epidural anesthesia. The change values of mean artery pressure were measured in both groups before administration and 3, 5, 10, 15 and 20 minutes after administration, and meanwhile the analgesia planes on both sides and adverse reactions during and after the surgery were observed. Results The change values of haemodynamics of group A were significantly higher than that of group B. Conclusions When light specific gravity bupivacaine is used in combined spinal and epidural anesthesia for elderly patients with hypertension in orthopedic surgeries of lower limbs, hypertension should be actively treated preoperatively. The appropriate dilation during the surgery promotes the anesthesia process to be more stable, with few complications postoperatively.