CAJ | 학술논문

目的初步评价脊椎-硬膜外联合阻滞改良法用于高龄患者膝关节置换术的可行性.方法高龄患者30例,拟行单侧膝关节置换术,性别不限,ASAⅡ或Ⅲ级,肝肾功能无严重异常,无椎管内麻醉禁忌证.采用脊椎-硬膜外联合阻滞改良法:蛛网膜下腔穿刺成功后,将1％盐酸罗哌卡因18 mg与脑脊液分4次混合稀释,向尾侧分次注入蛛网膜下腔;向硬膜外腔头侧注入生理盐水5ml,并免除置入硬膜外导管.观察麻醉期间BP、ECG、HR、RR、SpO2、感觉阻滞起效时间、运动阻滞程度、每小时尿量、术者对麻醉的满意度.结果感觉阻滞起效时间(16±6)s,运动阻滞程度Bromage评级为Ⅱ级或Ⅲ级,术者对麻醉满意率100％;阻滞平面均在T9以下,麻醉期间尿量未见异常,RR、SpO2、BP及HR维持在正常范围.结论采用1％盐酸罗哌卡因18 mg行改良法脊椎-硬膜外联合阻滞,起效迅速、麻醉效果满意,对循环、呼吸功能无明显不良影响,适用于高龄患者膝关节置换术.
목적 초보평개척추-경막외연합조체개량법용우고령환자슬관절치환술적가행성.방법 고령환자30례,의행단측슬관절치환술,성별불한,ASAⅡ혹Ⅲ급,간신공능무엄중이상,무추관내마취금기증.채용척추-경막외연합조체개량법:주망막하강천자성공후,장1％염산라고잡인18 mg여뇌척액분4차혼합희석,향미측분차주입주망막하강;향경막외강두측주입생리염수5ml,병면제치입경막외도관.관찰마취기간BP、ECG、HR、RR、SpO2、감각조체기효시간、운동조체정도、매소시뇨량、술자대마취적만의도.결과 감각조체기효시간(16±6)s,운동조체정도Bromage평급위Ⅱ급혹Ⅲ급,술자대마취만의솔100％;조체평면균재T9이하,마취기간뇨량미견이상,RR、SpO2、BP급HR유지재정상범위.결론 채용1％염산라고잡인18 mg행개량법척추-경막외연합조체,기효신속、마취효과만의,대순배、호흡공능무명현불량영향,괄용우고령환자슬관절치환술.
Objective To primarily evaluate the feasibility of using modified combined spinal-epidural anesthesia in elderly patients undergoing total knee arthroplasty.Methods Thirty elderly patients of both sexes,ASA physical status Ⅱ or Ⅲ,scheduled for elective unilateral total knee arthroplasty,without serious abnormal functions of liver and kidney and contraindications against spinal anesthesia,were enrolled in the study.The modified combined spinal-epidural anesthesia was used as follows:after a catheter was successfully placed into the subarachnoid space,1％ ropivacaine hydrochloride 18 mg was gradually mixed with the cerebrospinal fluid four times and the mixture was separately injected into the subarachnoid space caudally; normal saline 5 ml was injected into the epidural space in cephalad direction without placement of an epidural catheter.The invasive blood pressure,ECG,HR,RR and SpO2 during anesthesia,onset time of sensory block,degree of motor block,urine volume per hour and surgeon's satisfaction with anesthesia were recorded.Results The onset time of sensory block was (16 ± 6) s.Bromage scale for assessment of the degree of motor block was Ⅱ or Ⅲ.The rate of surgeon' s satisfaction with anesthesia was 100％.The level of block was below T9,and no abnormality was found in the urine volume during anesthesia with BP,HR,RR and SpO2 within the normal range.Conclusion The modified combined spinal-epidural anesthesia with 1％ ropivacaine hydrochloride 18 mg provides rapid onset and satisfactory anesthesia without the occurrence of respiratory depression,and thus is suitable for the elderly patients undergoing total knee arthroplasty.