CAJ | 학술논문

目的：探讨连续腰麻用于老年急性下肢动脉缺血患者手术的可行性。方法纳入2012年1月至2013年1月急性下肢动脉缺血行手术治疗的患者46例，年龄64~85岁，ASA Ⅲ级34例，IV 级12例。选择 L2，3或 L3，4间隙，蛛网膜下腔穿刺置入微导管，注入0.5％布比卡因重比重液1.0 ml，根据阻滞平面决定是否追加上述局麻药。比较麻醉前（T0）和首次给药后1 min（T1）、10 min（T2）、20 min（T3）、30 min（T4）、1 h（T5）、术毕时（T6）平均动脉压（MAP）和脉搏血氧饱和度（SpO2）的变化。观察麻醉效果及不良反应的发生率。结果46例患者均获得满意感觉阻滞平面。与 T0比较，MAP 在 T1-6降低（ P ﹤0.05），SpO2在 T1-6升高（ P ﹤0.05），MAP、SpO2在 T1-6各时间点间比较差异无统计学意义（ P ﹥0.05）。术中各时间点的 HR 之间比较差异无统计学意义（ P ﹥0.05）。麻醉后出现低血压6例（13％），呕吐3例（6.5％），术后随访无头痛和神经并发症出现。结论连续腰麻用于老年急性下肢动脉缺血患者手术麻醉效果确切，血流动力学平稳，不良反应小，用于该类患者是安全可行的。
목적：탐토련속요마용우노년급성하지동맥결혈환자수술적가행성。방법납입2012년1월지2013년1월급성하지동맥결혈행수술치료적환자46례，년령64~85세，ASA Ⅲ급34례，IV 급12례。선택 L2，3혹 L3，4간극，주망막하강천자치입미도관，주입0.5％포비잡인중비중액1.0 ml，근거조체평면결정시부추가상술국마약。비교마취전（T0）화수차급약후1 min（T1）、10 min（T2）、20 min（T3）、30 min（T4）、1 h（T5）、술필시（T6）평균동맥압（MAP）화맥박혈양포화도（SpO2）적변화。관찰마취효과급불량반응적발생솔。결과46례환자균획득만의감각조체평면。여 T0비교，MAP 재 T1-6강저（ P ﹤0.05），SpO2재 T1-6승고（ P ﹤0.05），MAP、SpO2재 T1-6각시간점간비교차이무통계학의의（ P ﹥0.05）。술중각시간점적 HR 지간비교차이무통계학의의（ P ﹥0.05）。마취후출현저혈압6례（13％），구토3례（6.5％），술후수방무두통화신경병발증출현。결론련속요마용우노년급성하지동맥결혈환자수술마취효과학절，혈류동역학평은，불량반응소，용우해류환자시안전가행적。
Objective To explore the feasibility of using continuous spinal anesthesia(CSA)in acute lower limb ischemia(ALLI)pa-tients undergoing operation. Methods Forty - six ALLI patients(38 males,8 females,aged 64 ~ 85 years old)undergoing operation in Beijing friendship hospital from January,2012 to January,2013 were included in the study. Their physical status were grade III - IV according to Anes-thesiologist Association of America( ASA). CSA were performed at L2,3 or L3,4 interspace. The patients received a microcatheter technique through a 21 gauge Sprotte spinal needle into subarachnoid space. Hypobaric 0. 5% bupivacaine solution 1. 0ml was injected. The same local anes-thetic was added if analgesia could not meet the needs of the operation. The change of mean arterial pressure(MAP)and pulse oxygen saturation at the time of before anesthesia(T0 ),1 minute(T1 ),10 minutes(T2 ),20 minutes(T3 ),30 minutes(T4 ),1 hour(T5 ),end of operation (T6 )were observed in this study. The anesthesia effect and side effect of CSA were recorded. Results All 46 patients received satisfactory sen-sory blockade extent. At the time of T1 - 6 ,MAP was significantly lower than T0 . SpO2 were significantly higher than T0 . But there were no signifi-cant difference in MAP and SpO2 at T1 - 6 . There was no significant change in heart rate(HR)during operation. However,6 patients(13% )ex-perienced at least one episode of hypotension and 3 patients(6. 5% )vomited after anesthesia. There were no postdural puncture headache and neurologic complication in all patients. Conclusion CSA can produce satisfactory anesthesia effect with stable hemodynamics and less side effect, which is a good choice in ALLI patients undergoing operation.