CAJ | 학술논문

背景：腰-硬联合麻醉和硬膜外麻醉均是老年人手术中常用的麻醉方式，各有优缺点。采用合适的麻醉方式保持循环稳定可以降低患者的手术风险和并发症，提高治疗成功率。目的：分析对比硬膜外麻醉与腰-硬联合麻醉在老年髋关节置换中的麻醉效果以及对于血流动力学的影响。方法：选择髋关节置换老年患者80例，随机分为两组，每组40例，试验组予以腰-硬联合麻醉，对照组予以硬膜外麻醉。对比两组患者各时间点的平均动脉压、心率和中心静脉压变化，感觉、运动阻滞起效及恢复时间，麻醉后30 min各阻滞平面和Bromage运动阻滞评分以及麻醉效果。结果与结论：对照组麻醉后5 min、30 min和术毕的平均动脉压显著低于麻醉前和试验组同时间点(P<0.05)；对照组麻醉后5 min、30 min和术毕的心率显著高于麻醉前和试验组同时间点(P<0.05)；对照组麻醉后5 min、30 min和术毕的中心静脉压显著高于麻醉前和试验组同时间点(P<0.05)。试验组的感觉、运动阻滞起效时间显著短于对照组，感觉、运动阻滞恢复时间显著长于对照组(P<0.01)。两组患者麻醉后30 min各阻滞平面和Bromage运动阻滞评分差异无显著性意义(P >0.05)。试验组的麻醉效果显著优于对照组(χ2=5.6917， P=0.0170<0.05)。提示与硬膜外麻醉相比，腰-硬联合麻醉可以减少髋关节置换患者的血流动力学变化，麻醉效果更佳。
배경：요-경연합마취화경막외마취균시노년인수술중상용적마취방식，각유우결점。채용합괄적마취방식보지순배은정가이강저환자적수술풍험화병발증，제고치료성공솔。목적：분석대비경막외마취여요-경연합마취재노년관관절치환중적마취효과이급대우혈류동역학적영향。방법：선택관관절치환노년환자80례，수궤분위량조，매조40례，시험조여이요-경연합마취，대조조여이경막외마취。대비량조환자각시간점적평균동맥압、심솔화중심정맥압변화，감각、운동조체기효급회복시간，마취후30 min각조체평면화Bromage운동조체평분이급마취효과。결과여결론：대조조마취후5 min、30 min화술필적평균동맥압현저저우마취전화시험조동시간점(P<0.05)；대조조마취후5 min、30 min화술필적심솔현저고우마취전화시험조동시간점(P<0.05)；대조조마취후5 min、30 min화술필적중심정맥압현저고우마취전화시험조동시간점(P<0.05)。시험조적감각、운동조체기효시간현저단우대조조，감각、운동조체회복시간현저장우대조조(P<0.01)。량조환자마취후30 min각조체평면화Bromage운동조체평분차이무현저성의의(P >0.05)。시험조적마취효과현저우우대조조(χ2=5.6917， P=0.0170<0.05)。제시여경막외마취상비，요-경연합마취가이감소관관절치환환자적혈류동역학변화，마취효과경가。
BACKGROUND:Epidural anesthesia and combined spinal-epidural anesthesia are commonly used approaches for surgical anesthesia in elderly patients, and each has their advantages and disadvantages. Suitable anesthesia approach can stabilize the cycle, reduce the surgical risk and complications, and improve the success rate of treatment. OBJECTIVE:To analyze and compare the anesthesia effect of epidural anesthesia and combined spinal-epidural anesthesia in the elderly patients during hip arthroplasty, and explore the effect of different approaches on the on hemodynamics. METHODS:80 elderly patients undergoing hip arthroplasty were randomly divided into experimental group and control group, with 40 cases in each group. The experimental group received combined spinal-epidural anesthesia. The control group received epidural anesthesia. The mean arterial pressure, central venous pressure, and heart rate variability at each time point, sensory and motor block onset and recovery times, each block plane after 30 minutes of anesthesia, Bromage score of motor block, and anesthetic effects in both groups of patients were compared. RESULTS AND CONCLUSION:The mean arterial pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly lower than the experimental group at the same time point and before anesthesia (P<0.05). The heart rate at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P<0.05). The central venous pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P<0.05). Sensory and motor block onset time in the experimental group was significantly shorter, while the sensory and motor block recovery time was significantly higher than the control group (P<0.01). After patients in the two groups were anesthetized for 30 minutes, each block plane and Bromage score of motor block showed no significant difference (P>0.05). Anesthetic effect in the experimental group was significantly better than the control group(χ2=5.691 7, P=0.017 0<0.05). Compared with epidural anesthesia, the combined spinal-epidural anesthesia can reduce hemodynamic changes in patients with hip replacement surgery, and has better anesthesia effect.