CAJ | 학술논문

背景：老年高血压患者常合并器官组织缺血，在接受关节置换的过程中较易出现各种风险。为保证置换手术的顺利进行，提高安全性，需要选择合适的麻醉方式。 　　目的：探讨硬膜外复合小剂量静脉麻醉在老年高血压全膝关节置换中的应用安全性。 　　方法：从2013年12月至2014年12月河北医科大学附属第三医院收治的老年高血压关节置换患者中选择64例，随机分为对照组和观察组，每组32例，分别给予全凭静脉麻醉和硬膜外复合小剂量静脉麻醉。测定麻醉前、麻醉诱导后、麻醉后10 min、应用骨水泥后10 min、置换结束时两组患者的收缩压、舒张压、心率、血氧饱和度、呼吸率变化；记录置换中血管活性药物(包括麻黄碱、多巴胺等)的使用率以及置换后不良事件发生情况等。 　　结果与结论：较之麻醉前，两组患者在麻醉后10 min、应用骨水泥后10 min的收缩压、舒张压均显著降低，血氧饱和度均升高，差异均有显著性意义(P<0.05)；置换结束时对照组收缩压、舒张压及呼吸率显著高于观察组，差异均有显著性意义(P<0.05)。观察组和对照组使用血管活性药物，包括麻黄碱、多巴胺等的分别有3例和15例，使用率经比较差异有显著性意义(P <0.05)。且对照组置换后有5例患者出现呼吸功能不全，给予短期呼吸机支持后明显改善。提示与全凭静脉麻醉相比，在老年高血压患者全膝关节置换中实施硬膜外复合小剂量静脉麻醉具有更高的安全性。
배경：노년고혈압환자상합병기관조직결혈，재접수관절치환적과정중교역출현각충풍험。위보증치환수술적순리진행，제고안전성，수요선택합괄적마취방식。 　　목적：탐토경막외복합소제량정맥마취재노년고혈압전슬관절치환중적응용안전성。 　　방법：종2013년12월지2014년12월하북의과대학부속제삼의원수치적노년고혈압관절치환환자중선택64례，수궤분위대조조화관찰조，매조32례，분별급여전빙정맥마취화경막외복합소제량정맥마취。측정마취전、마취유도후、마취후10 min、응용골수니후10 min、치환결속시량조환자적수축압、서장압、심솔、혈양포화도、호흡솔변화；기록치환중혈관활성약물(포괄마황감、다파알등)적사용솔이급치환후불량사건발생정황등。 　　결과여결론：교지마취전，량조환자재마취후10 min、응용골수니후10 min적수축압、서장압균현저강저，혈양포화도균승고，차이균유현저성의의(P<0.05)；치환결속시대조조수축압、서장압급호흡솔현저고우관찰조，차이균유현저성의의(P<0.05)。관찰조화대조조사용혈관활성약물，포괄마황감、다파알등적분별유3례화15례，사용솔경비교차이유현저성의의(P <0.05)。차대조조치환후유5례환자출현호흡공능불전，급여단기호흡궤지지후명현개선。제시여전빙정맥마취상비，재노년고혈압환자전슬관절치환중실시경막외복합소제량정맥마취구유경고적안전성。
BACKGROUND:Elderly hypertensive patients often associated with organ and tissue ischemia. Al kinds of risks are easy to appear in the process of undergoing arthroplasty. To ensure the smooth operation and to improve the safety of the surgery treatment, it is needed to choose an appropriate mode of anesthesia. OBJECTIVE:To explore the application security of epidural combined with smal dose of intravenous anesthesia in total knee arthroplasty in elderly hypertensive patients. METHODS:A total of 64 elderly hypertensive patients with arthroplasty in the Third Hospital of Hebei Medical University from December 2013 to December 2014 were selected and were divided into control group (32 cases) and observation group (32 cases). They were given total intravenous anesthesia and epidural block combined with smal dose of intravenous anesthesia. Systolic blood pressure, diastolic blood pressure, heart rate, blood oxygen saturation and changes in respiratory rate were detected before anesthesia, after anesthesia induction, 10 minutes after anesthesia, 10 minutes after use of bone cement, and at the end of arthroplasty in both groups. The usage of vasoactive drugs (including ephedrine and dopamine) during arthroplasty and adverse events after arthroplasty were recorded. RESULTS AND CONCLUSION:Compared with pre-anesthesia, systolic blood pressure and diastolic blood pressure were significantly reduced and blood oxygen saturation was increased at 10 minutes after anesthesia and 10 minutes after the application of bone cement in both groups (P<0.05). In the end of arthroplasty, systolic blood pressure, diastolic blood pressure and respiratory rate were significantly higher in the control group than in the observation group (P<0.05). A total of 3 cases in the observation group and 15 cases in the control group used vasoactive drugs (including ephedrine and dopamine), and there was a significant difference in its usage (P<0.05). Moreover, five patients in the control group experienced respiratory insufficiency, which was apparently improved after given the short-term ventilator support. These results confirm that compared with the total intravenous anesthesia, epidural block combined with smal dose of intravenous anesthesia showed a high safety during total knee arthroplasty in elderly hypertensive patients.