CAJ | 학술논문

背景：目前腰麻-硬膜外联合麻醉中，其用药方式与单独腰麻和硬膜外麻醉用药无太大差别，即先以较大剂量腰麻，而硬膜外用于确保效果和术后镇痛。近年来国内外有学者提出一些新的观点：腰麻先给予小剂量、低浓度的局麻药，再予硬膜外衔接以小剂量、低浓度的局麻药，真正发挥腰麻与硬膜外的联合作用，可以达到完善麻醉效果，以减少不良反应和并发症。 　　目的：分析小剂量低密度腰麻-硬膜外联合麻醉在老年下肢骨折修复手术中的应用效果。 　　方法：选取惠州市中心人民医院择期行单侧下肢手术患者68例，按照麻醉方式分为对照组与观察组，各34例。对照组采用连续硬膜外麻醉，观察组采用小剂量低密度腰麻-硬膜外联合麻醉。对比分析两组患者麻醉阻滞起效时间、阻滞完善时间、麻醉药物用量、下肢改良Bromage评分及血流动力学变化。 　　结果与结论：观察组麻醉阻滞起效时间、阻滞完善时间、麻醉药物用量及下肢改良Bromage评分与对照组比较，观察组优于对照组，差异有显著性意义(P <0.05)。两组患者麻醉后5，10 min平均动脉压显著低于麻醉前(P <0.05)，其余指标差异无显著性意义。两组患者术后生命体征平稳，且无术后认知功能障碍发生。提示采用小剂量低密度腰麻联合硬膜外麻醉具有起效快、用量少、阻滞完全、镇痛效果好等优点。临床将其应用于老年下肢骨折修复手术，对患者血流动力学影响较小，且可达到较为完善的镇痛效果。
배경：목전요마-경막외연합마취중，기용약방식여단독요마화경막외마취용약무태대차별，즉선이교대제량요마，이경막외용우학보효과화술후진통。근년래국내외유학자제출일사신적관점：요마선급여소제량、저농도적국마약，재여경막외함접이소제량、저농도적국마약，진정발휘요마여경막외적연합작용，가이체도완선마취효과，이감소불량반응화병발증。 　　목적：분석소제량저밀도요마-경막외연합마취재노년하지골절수복수술중적응용효과。 　　방법：선취혜주시중심인민의원택기행단측하지수술환자68례，안조마취방식분위대조조여관찰조，각34례。대조조채용련속경막외마취，관찰조채용소제량저밀도요마-경막외연합마취。대비분석량조환자마취조체기효시간、조체완선시간、마취약물용량、하지개량Bromage평분급혈류동역학변화。 　　결과여결론：관찰조마취조체기효시간、조체완선시간、마취약물용량급하지개량Bromage평분여대조조비교，관찰조우우대조조，차이유현저성의의(P <0.05)。량조환자마취후5，10 min평균동맥압현저저우마취전(P <0.05)，기여지표차이무현저성의의。량조환자술후생명체정평은，차무술후인지공능장애발생。제시채용소제량저밀도요마연합경막외마취구유기효쾌、용량소、조체완전、진통효과호등우점。림상장기응용우노년하지골절수복수술，대환자혈류동역학영향교소，차가체도교위완선적진통효과。
BACKGROUND:The medication of spinal-epidural anesthesia does not have great differences as compared with spinal anesthesia and epidural anesthesia alone. That is, a large-dose spinal anesthesia is first used. Epidural anesthesia is utilized to ensure effects and postoperative analgesia. Recent scholars proposed some new ideas: smal-dose and low-concentration local spinal anesthetics are first used, and smal-dose and low-concentration local epidural anesthetics are then utilized, which realy plays a joint role in spinal and epidural anesthesia, and achieves perfect anesthesia outcomes, and reduces adverse reactions and complications. OBJECTIVE:To analyze application outcomes of smal-dose and low-density local spinal-epidural anesthesia to repair surgery of elderly lower limb fractures. METHODS:A total of 68 cases, who would receive the surgery of unilateral lower limb in the Huizhou Central People’s Hospital, were selected in this study. They were equaly assigned to control group and observation group according to the anesthesia manner. Each group contained 34 cases. Control group received continuous epidural anesthesia. Observation group received smal-dose and low-density local spinal-epidural anesthesia. Onset time of anesthesia, blocking perfect time, the amount of narcotic drugs, lower limbs modified Bromage score and hemodynamic alterations were compared and analyzed between two groups. RESULTS AND CONCLUSION:Onset time of anesthesia, blocking perfect time, the amount of narcotic drugs, and lower limbs modified Bromage score were better in the observation group than in the control group (P < 0.05). Mean arterial pressure was significantly lower at 5 and 10 minutes after anesthesia than that before anesthesia in both groups (P < 0.05). No significant difference was detected in other indexes. Patients from the two groups had stable vital signs. No postoperative cognitive dysfunction occurred. These data indicated that smal-dose and low-density local spinal-epidural anesthesia was characterized by rapid onset, less dose, complete block and good analgesia. It is used in the repair surgery of lower extremity fractures in elderly, and has little effect on hemodynamics in patients, and can achieve a more perfect analgesia.