CAJ | 학술논문

目的：探讨外周神经阻滞在老年骨科下肢手术的应用效果。方法选择拟行下肢骨科手术的老年患者60例，随机均分为外周神经阻滞组（N组）和腰麻组（E组）(n=30)。N组给予0.5%罗哌卡因20 mL行坐骨神经阻滞或0.5%罗哌卡因15 mL行股神经阻滞。E组选择L 2～3或者L 3～4间隙行蛛网膜下腔阻滞，穿刺成功后给予0.75%布比卡因2.0 mL加10%葡萄糖1.0 mL。记录麻醉前、给药后15 min、30 min和手术结束即刻患者的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2），观察不良反应发生情况及术后12、24h患者的VAS评分。结果2组均达到了满意的麻醉效果，麻醉前2组的HR、MAP差异无统计学意义；2组各时点SpO 2差异无统计学意义；N组各时点HR和MAP差异无统计学意义；与麻醉前相比，E组麻醉后15 min、30 min和手术结束时MAP下降，HR降低（P<0.05）；与N组相比，E组麻醉后15 min、30 min和手术结束时MAP下降[（69.5±6.8）、（75.1±6.6）、（78.3±6.3）mmHg]， HR[（76.0±8.5）、（77.1±8.5）、（75.4±8.9）次/min]降低（P<0.05），E组术后12 h患者VAS评分（3.40±1.35）升高（P<0.05），恶心呕吐（33.3%）、尿潴留（23.3%）发生情况升高（P<0.05）；术后24h2组VAS评分差异无统计学意义。结论老年患者实施单侧下肢手术采用外周神经阻滞麻醉效果满意，生命体征平稳，发生不良反应少，术后镇痛效果好。
목적：탐토외주신경조체재노년골과하지수술적응용효과。방법선택의행하지골과수술적노년환자60례，수궤균분위외주신경조체조（N조）화요마조（E조）(n=30)。N조급여0.5%라고잡인20 mL행좌골신경조체혹0.5%라고잡인15 mL행고신경조체。E조선택L 2～3혹자L 3～4간극행주망막하강조체，천자성공후급여0.75%포비잡인2.0 mL가10%포도당1.0 mL。기록마취전、급약후15 min、30 min화수술결속즉각환자적심솔（HR）、평균동맥압（MAP）、맥박혈양포화도（SpO2），관찰불량반응발생정황급술후12、24h환자적VAS평분。결과2조균체도료만의적마취효과，마취전2조적HR、MAP차이무통계학의의；2조각시점SpO 2차이무통계학의의；N조각시점HR화MAP차이무통계학의의；여마취전상비，E조마취후15 min、30 min화수술결속시MAP하강，HR강저（P<0.05）；여N조상비，E조마취후15 min、30 min화수술결속시MAP하강[（69.5±6.8）、（75.1±6.6）、（78.3±6.3）mmHg]， HR[（76.0±8.5）、（77.1±8.5）、（75.4±8.9）차/min]강저（P<0.05），E조술후12 h환자VAS평분（3.40±1.35）승고（P<0.05），악심구토（33.3%）、뇨저류（23.3%）발생정황승고（P<0.05）；술후24h2조VAS평분차이무통계학의의。결론노년환자실시단측하지수술채용외주신경조체마취효과만의，생명체정평은，발생불량반응소，술후진통효과호。
Objective To investigate the efifciency of peripheral nerve block in elderly patients undering lower limb surgery.Methods Sixty ASAⅠ-Ⅲ patients between sixty and eighty years old who were scheduled to undergo unilateral lower limb surgery were randomly allocated into two groups, with 30 patients in each group. In group N, the femoral and sciatic nerves were located injecting with 20 mL and 25 mL of 0.5% ropivacaine, respectively. In group E, 2mL of 0.75% bupivacaine and 1mL of 10% glucose were injected at spinal interspace L2-3 or L2-3 for subarachnoid anesthesia. HR, MAP, and SpO2 were observed before anesthesia, 15 and 30 minutes after anesthesia and at the end of operation. Adverse reactions and VAS were recorded after operation 12 hours and 24 hours.Results Patients were satisifed with the anesthic effects, and no signiifcant differences were found in HR, MAP before anesthesia between group N and group E; there were no signiifcant differences in SpO2 at each time of two groups; compared with the time before anesthesia, MAP and HR was decreased at time of 15min and 30 min after anesthesia and operation ends in group N. Compared with group E, MAP and HR was decreased at time of 15min and 30 min after anesthesia and operation ends, VAS scores were signiifcantly elevated at 12 hours after operation, and adverse reactions incidence was signiifcantly decreased in group N (P<0.05).Conclusion Peripheral nerve block applied in elderly patients undering lower limb orthopedics operation has more advantages than spinal anesthesia, with sable vital signs, less postoperative complications, and better postoperative analgesia.