CAJ | 학술논문

目的：比较神经刺激仪引导下的的腰丛－坐骨神经阻滞与连续硬膜外阻滞在高龄患者单侧股骨头置换手术中的临床效果。方法选择美国麻醉师协会Ⅱ～Ⅲ级拟行单侧股骨头置换手术的老年患者40例，随机分为腰丛－坐骨神经联合阻滞组（N 组，n ＝20）和硬膜外阻滞组（E 组，n ＝20）。N 组行神经刺激仪辅助下腰丛－坐骨神经阻滞，局部麻醉药为0．3％罗哌卡因和0．3％利多卡因混合液，腰丛阻滞剂量30～35 mL，坐骨神经阻滞剂量25～30 mL；E 组行连续硬膜外麻醉，硬膜外腔向头侧置管，试验量无异常后给予1％利多卡因＋0．5％罗哌卡因6～8 mL。记录2组患者麻醉前、麻醉后5 min、麻醉后10 min、手术开始时和手术开始后30 min（T0～T4）血压和心率的变化，并观察2组患者麻醉操作时间、麻醉效果及术后不良反应情况。结果 T2（麻醉后10 min）及 T3（手术开始时）E 组患者的平均动脉压均明显低于基础值，较 N 组波动大（P ＜0．01），N 组患者均无明显变化；2组患者心率均无明显变化。2组患者麻醉效果差异无统计学意义（P ＞0．05），E 组术后不良反应明显多于 N 组（P ＜0．01）。结论神经刺激仪引导下的腰丛－坐骨神经阻滞麻醉在高龄患者股骨头置换手术中可以达到与硬膜外阻滞相同的效果，并具有对循环干扰小及术后并发症少等优点。
목적：비교신경자격의인도하적적요총－좌골신경조체여련속경막외조체재고령환자단측고골두치환수술중적림상효과。방법선택미국마취사협회Ⅱ～Ⅲ급의행단측고골두치환수술적노년환자40례，수궤분위요총－좌골신경연합조체조（N 조，n ＝20）화경막외조체조（E 조，n ＝20）。N 조행신경자격의보조하요총－좌골신경조체，국부마취약위0．3％라고잡인화0．3％리다잡인혼합액，요총조체제량30～35 mL，좌골신경조체제량25～30 mL；E 조행련속경막외마취，경막외강향두측치관，시험량무이상후급여1％리다잡인＋0．5％라고잡인6～8 mL。기록2조환자마취전、마취후5 min、마취후10 min、수술개시시화수술개시후30 min（T0～T4）혈압화심솔적변화，병관찰2조환자마취조작시간、마취효과급술후불량반응정황。결과 T2（마취후10 min）급 T3（수술개시시）E 조환자적평균동맥압균명현저우기출치，교 N 조파동대（P ＜0．01），N 조환자균무명현변화；2조환자심솔균무명현변화。2조환자마취효과차이무통계학의의（P ＞0．05），E 조술후불량반응명현다우 N 조（P ＜0．01）。결론신경자격의인도하적요총－좌골신경조체마취재고령환자고골두치환수술중가이체도여경막외조체상동적효과，병구유대순배간우소급술후병발증소등우점。
Objective To compare the efficacy of lumbar plexus/sciatic nerve block using peripheral nerve stimulator with epidural anesthesia in the unilateral femoral head replacement surgery of elderly patients.Methods Forty patients,ASA physical status ofⅡ - Ⅲ,undergoing the unilateral femoral head replacement surgery were randomly divided into two groups:group N (lumbar plexus/sciatic nerve block group,n = 20);group E(epidural anesthesia group,n = 20). The patients in group N received lumbar plexus/sciatic nerve block using peripheral nerve stimulator.The local anesthetic drug was the mixed solution of 0.3% ropivacaine and 0.3%lidocaine,and the amount of drug for lumber plexus block was 30- 35 mL and 25- 30 mL for sciatic plexus block.The patients in group E received epidural anestheisa and epidural catheter headward.The local anesthetic drug was the mixed solution of 1% lidocaine and 0.5% ropivicaine, 6-8 mL would be given through epidural catheter after test dose.The blood pressure and heart rate were measured before anesthesia,5,10 min after anesthesia,operations beginning and 30 min later(T0 - T4 ).Anesthesia procedure time,adverse reactions and postoperative complications of two groups were recorded.Results The mean artery pressure (MAP) of T2 (10 min after anesthesia)and T3 (operation beginning)in group E were decreased than those of baseline(P <0.01);compared with group N,MAP of T2 and T3 in group E were lower.The heart rates were stable in both groups.Anaesthesia effect of two groups had no significant difference(P >0.05). The complications of group N were less than those of group E (P < 0.01 ).Conclusion The anesthetic strategy of lumbar plexus/sciatic nerve block using peripheral nerve stimulator will lead to precise anesthesia effect.Compared with epidural anesthesia,nerve block had stable hemodynamics and a few complications.