CAJ | 학술논문

目的：总结腰椎-硬膜外（腰-硬）联合麻醉用于高龄（75岁以上）患者的临床经验。方法对重庆市第三人民医院2013年1～11月56例采用腰-硬联合麻醉的高龄患者的临床资料进行回顾性分析，重点收集麻醉起效和维持时间，麻醉中血流动力学变化情况，麻醉中辅助药物使用情况及并发症等资料。结果蛛网膜下腔注药后平均（54±10）s开始出现麻醉平面，平均（5．8±1．2）min后麻醉平面固定，阻滞平面上界胸8～10。与麻醉前基础值比较，麻醉后平均动脉压有所下降，差异有统计学意义（P＜0．05），但都在正常范围。麻醉中患者生命体征平稳，全部在腰-硬联合麻醉下顺利完成手术。术中有1例患者因平均动脉压（MAP）过低给予麻黄碱纠正；有1例患者MAP升高超过麻醉前基础值30％进行降压处理；另有1例患者出现心率低于55次/分，给予阿托品0．5 mg后纠正，其余患者术中生命体征平稳。麻醉中未观察到明显呼吸抑制，脉搏氧饱和度均维持在96％以上。有9例患者术中经硬膜外导管追加了局部麻醉药物，有21例患者术中给予芬太尼、咪达唑仑或丙泊酚辅助。患者术毕未见恶心、呕吐、头痛等现象，未观察到明确麻醉并发症。结论腰-硬联合麻醉可安全用于高龄患者，其起效迅速，效果完善，麻醉中生命体征稳定，充分的麻醉前准备和完善的麻醉管理措施，有助于保障麻醉的安全性。
목적：총결요추-경막외（요-경）연합마취용우고령（75세이상）환자적림상경험。방법대중경시제삼인민의원2013년1～11월56례채용요-경연합마취적고령환자적림상자료진행회고성분석，중점수집마취기효화유지시간，마취중혈류동역학변화정황，마취중보조약물사용정황급병발증등자료。결과주망막하강주약후평균（54±10）s개시출현마취평면，평균（5．8±1．2）min후마취평면고정，조체평면상계흉8～10。여마취전기출치비교，마취후평균동맥압유소하강，차이유통계학의의（P＜0．05），단도재정상범위。마취중환자생명체정평은，전부재요-경연합마취하순리완성수술。술중유1례환자인평균동맥압（MAP）과저급여마황감규정；유1례환자MAP승고초과마취전기출치30％진행강압처리；령유1례환자출현심솔저우55차/분，급여아탁품0．5 mg후규정，기여환자술중생명체정평은。마취중미관찰도명현호흡억제，맥박양포화도균유지재96％이상。유9례환자술중경경막외도관추가료국부마취약물，유21례환자술중급여분태니、미체서륜혹병박분보조。환자술필미견악심、구토、두통등현상，미관찰도명학마취병발증。결론요-경연합마취가안전용우고령환자，기기효신속，효과완선，마취중생명체정은정，충분적마취전준비화완선적마취관리조시，유조우보장마취적안전성。
Objective To summarize the experiences of clinical practice of combined spinal-epidural anesthesia in patients older than 75 years .Methods A retrospective analysis was performed in 56 cases of older than 75 years , receiving combined spinal-epidural anesthesia from Jan .to Nov .in 2013 ,to investigate onset and duration of anesthe-sia ,hemodynamic changes ,supplementary drugs used during anesthesia and complications after anesthesia .Results Average time from subarachnoid injection to onset of anesthesia was (54 ± 10)s ,fixed block could be identified after (5 .8 ± 1 .2) min ,and the highest level of anesthesia appeared at T8 to T10 region .Compared to T0 (baseline values before anesthesia) ,the mean arterial pressure (MAP) after anesthesia decreased (P< 0 .05) ,but was in normal range .All surgeries were completed under spinal-epidural anesthesia .One patient was given ephedrine because of low MAP .One patient needed antihypertensive treatment because MAP increased more than 30% of baseline before anes-thesia .One patient needed atropine 0 .5 mg to correct heart rate .Vital signs of the remaining patients were stable .No significant respiratory depression was observed ,and pulse oxygen saturation levels of all patients were maintained o-ver 96% .Nine patients need extra local anesthetic ,added through the epidural catheter .Twenty-one patients were given fentanyl ,midazolam or propofol as supplementary drugs .No patient was with nausea ,vomiting ,headache and other phenomena ,and anesthetic complications were not observed .Conclusion With rapid onset and improved effects ,combined spinal-epidural anesthesia could be used safely in patients older than 75 years .Fully preanesthetic preparations and excellent management of anesthesia during the operation might be benefit for the success and securi-ty of anesthesia .