CAJ | 학술논문

目的：探讨硬膜外麻醉在80岁以上老年患者髋关节置换术的可行性。方法：收治ASA Ⅱ～Ⅲ级接受全髋和人工股骨头置换术80岁以上老年患者120例，随机分为硬膜外组(A组)和全麻组(B组)，硬膜外组选用L2～3硬膜外穿刺置入硬膜外导管，平卧位后注入2%利多卡因3 mL 作为试验量，用2%利多卡因和0.75%左布比卡因混合液为维持用药。全麻组用咪达唑仑、舒芬太尼、依托咪酯、顺阿曲库铵诱导气管插管后机控通气，术中用七氧醚和瑞芬太尼维持麻醉。观察两组患者血流动力学变化和采用简易精神状况检测法(MMS)检测两组患者术后24、72 h认知功能障碍，以及观察术后1周内发生肺部感染和肺栓塞情况。结果：硬膜外组血流动力学平稳，而全麻组血流动力学波动大。硬膜外组对认知功能影响轻，而全麻组对认知功能影响严重，而且肺部感染、肺栓塞发生率高。结论：硬膜外麻醉用于高龄患者髋部手术是一种简单、安全、有效的麻醉方法。
목적：탐토경막외마취재80세이상노년환자관관절치환술적가행성。방법：수치ASA Ⅱ～Ⅲ급접수전관화인공고골두치환술80세이상노년환자120례，수궤분위경막외조(A조)화전마조(B조)，경막외조선용L2～3경막외천자치입경막외도관，평와위후주입2%리다잡인3 mL 작위시험량，용2%리다잡인화0.75%좌포비잡인혼합액위유지용약。전마조용미체서륜、서분태니、의탁미지、순아곡고안유도기관삽관후궤공통기，술중용칠양미화서분태니유지마취。관찰량조환자혈류동역학변화화채용간역정신상황검측법(MMS)검측량조환자술후24、72 h인지공능장애，이급관찰술후1주내발생폐부감염화폐전새정황。결과：경막외조혈류동역학평은，이전마조혈류동역학파동대。경막외조대인지공능영향경，이전마조대인지공능영향엄중，이차폐부감염、폐전새발생솔고。결론：경막외마취용우고령환자관부수술시일충간단、안전、유효적마취방법。
Objective:To explore the feasibility of epidural anesthesia in elderly patients of over the age of 80 in total hip replacement.Methods:120 patients over 80 years old with ASA Ⅱ to Ⅲ were selected.They were treated by total hip and femoral head replacement.They were randomly divided into the epidural anesthesia group(A group) and the general anesthesia group(B group).The epidural group was given L2~3 epidural puncture into the epidural catheter.After flat supine,2% lidocaine 3 mL was injected as a test weight,and 2% lidocaine and 0.75% bupivacaine mixture was used as maintenance therapy.In the general anesthesia group,midazolam,etomidate,sufentanil,CIS atracurium were used to induce endotracheal intubation,and then we used the machine controlled ventilation,during the operation,seven oxygen ether and remifentanil were used to maintain anesthesia.We observed the changes of hemodynamics,and used mini mental status detection method(MMS) for detection of cognitive impairment of two groups of patients at 24 hours and 72 hours after operation,and we observed the pulmonary infection and pulmonary embolism in 1 week after operation.Results:In the epidural group,the hemodynamics was stable;in the general anesthesia group, the hemodynamic fluctuations was big.In the epidural group,effects on cognitive function was light;in the general anesthesia group, cognitive function influence was serious,and pulmonary infection,pulmonary embolism occurrence rate was high.Conclusion:Epidural anesthesia for elderly patients with hip surgery was a simple,safe and effective anesthesia method.