期刊文献+

椎管内麻醉不同阻滞平面对高龄全髋关节置换术患者术中血液动力学稳定性影响的探讨 被引量:6

An exploratory study on influence of combined spinal and epidural anesthesia at different anesthetic levels on stability of hemodynamics in elderly patients undergoing total hip arthroplasty
下载PDF
导出
摘要 目的观察腰麻联合硬膜外麻醉不同阻滞平面对全髋关节置换术患者术中血液动力学变化的影响。方法随机选择全髋关节置换手术病人39例;所有实施手术病人行腰麻联合硬膜外麻醉。麻醉方法:选择L2~3间隙穿刺,腰麻药物使用重比重0.5%罗哌卡因,硬膜外腔向头端置管。观察不同麻醉平面(T10、T8、T6~7)手术过程中不同时间血液动力学变化。结果①不同麻醉平面病人组一般情况,包括年龄、体质量、性别、ASA评分、心血管系统并发症及手术、麻醉时间无统计学差异;②各组组内的术前与麻醉后各时间点平均动脉压值比较差异有统计学意义(P<0.05)。③T10组麻醉后,各手术时间点的平均动脉压与其它两组的数据比较有显著变化改变,其中T6-7组对平均动脉压影响最大(P<0.05)。④呼吸及脉搏各组间及组内比较无统计学差异(P>0.05)。结论全髋关节置换术,椎管内麻醉平面控制在T10水平,对患者血液动力学影响最小,尤其对有心血管系统合并症者是一种安全的麻醉控制方法。 Objective To observe changes of hemodynamics caused by combined spinal and epidural anesthesia (CSEA) at different anesthetic levels during total hip arthroplasty (THA). Methods Thirty -nine patients were randomly selected to perform THA under CSEA. The puncture site was at the space between second and third lumbar vertebrae. The spinal anesthesia was performed with 0.5% ropivacalne and a cath- eter was left in epidural space towards the head. Patients were allocated into group Tl0, Ts , and T6 -7 according to anesthetic levels. Changes in hemodynamics and rates of respiration of patients in each group were observed at different time points during operation. Results No significant difference had been found among age, body weight, sex, ASA classification, cardiovascular complications, anesthetic duration and operating time between each group. Significant difference in mean arterial blood pressure was found between the period before and after anesthesia in each group ( P 〈0.05 ). More significant changes in mean arterial blood pressure were found in group T8 and group T6 -7 than group T10, and the most significant change in mean arterial blood pressure had been found in group T6 - 7 ( P 〈 0.05 ). No significant change was found in pulse rate and rate of respiration in patients of each group ( P 〉 0. 05). Conclusion CSEA at T10 anesthetic level for THA causes less changes in hemodynamics and it is a safe method especially for elderly patients with cardiovascular complications.
作者 李杰 丁冠男
出处 《临床和实验医学杂志》 2012年第17期1371-1373,共3页 Journal of Clinical and Experimental Medicine
关键词 全髋关节置换术 腰麻联合硬膜外麻醉 阻滞平面 血液动力学 Total hip arthroplasty (THA) Combined spinal and epidural anesthesia (CSEA) Anesthetic level Hemodynamics
  • 相关文献

参考文献9

  • 1Murray JM, Derbyshire S, Shields MO. Lower limb blocks [ J]. Anaes- thesia, 2010,65 ( Suppl 1 ) :57 - 66.
  • 2曹亲亲,徐旭仲,卢园园,陈丽梅,郭献阳.在老年患者股骨粗隆骨折手术中应用腰丛阻滞与硬膜外阻滞的效果比较[J].中华医学杂志,2008,88(37):2614-2617. 被引量:9
  • 3Minville V, Fourcade O, Grousset D, et al. Spinal anesthesia using sin- gle injection small - dose bupivacaine versus continuous catheter injec- tion techniques for surgical repair of hip fracture in elderly patients [ J]. Anesth Analg, 2006,102(5 ) : 1559 - 1563.
  • 4Pollard JB. Cardiac arrest during spinal anesthesia: common mecha- nisms and strategies for prevention [ J]. Anesth Analg, 2001,92 (1) : 252 - 256.
  • 5Tran D, Clemente A, Finlayson RJ. A review of approaches and tech- niques for lower extremity nerve blocks[ J]. Can J Anaesth, 2007,54 ( 11 ) :922 -934.
  • 6李挺,金勉,徐旭仲,卢园园.腰丛-坐骨神经阻滞应用于老年病人下肢手术[J].温州医学院学报,2005,35(5):376-378. 被引量:24
  • 7Touray ST, de Leeuw MA, Zuurmond WW, et al. Psoas compartment block for lower extremity surgery: a metaanalysis [ J ]. Br J Anaesth, 2008,101 (6) :750 - 760.
  • 8Duarte LT, Beraldo PS, Saraiva RA. Epidural lumbar block or lumbar plexus block combined with general anesthesia: efficacy and hemodyo namic effects on total hip arthroplasty [J]. Rev Bras Anestesiol,2009, 59(6) :649 - 664.
  • 9Utebey G, Akkaya T, Alptekin A, et al. The effects of lumbar plexus block and epidural block on total blood loss and postoperative analgesia in total hip arthroplasty[ J]. Agri, 2009,21 (2) :62 -68.

二级参考文献17

  • 1李挺,金勉,徐旭仲,卢园园.腰丛-坐骨神经阻滞应用于老年病人下肢手术[J].温州医学院学报,2005,35(5):376-378. 被引量:24
  • 2郭献阳,徐旭仲,陈丽梅,李挺,余微萍.罗哌卡因单用及复合不同浓度利多卡因对坐骨神经起效时间的影响[J].温州医学院学报,2007,37(3):240-243. 被引量:14
  • 3Ho AM, Karmakar MK. Combined paraverlebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis. Can J Anaesth, 2002, 49: 946-950.
  • 4Faas CL, Acosta FJ, Campbell MD, et al. The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain, urinary, retention, and mobility following inguinal herniorrhaphy. AANA J, 2002,70:441-447.
  • 5Greengrass RA, Klein SM, D'Ercole FJ, et al and sciatic nerve block for ropivacaine and bupivacaine. 1096. knee arthroplasty Lumbar plexus comparison of Can J Anaesth, 1998, 45:1096.
  • 6Pianezza A, Gilbert ML, Minville V, et al. A modified midfemoral approach to the sciatic nerve block: a correlation between evoked motor response and sensory block. Anesth Analg,2007, 105 : 528-530.
  • 7Domingo-Triado V, Selfa S, Martinez F, el al. Ultrasound guidance for lateral midfemoral sciatic nerve block : a prospective, comparative, randomized study. Anesth Analg, 2007, 104 : 1270- 1274.
  • 8Raimer C, Priem K, Wiese AA, et al. Continuous psoas and sciatic block after knee arthroplasty: good effects compared to epidural analgesia or i. v. opioid analgesia: a prospective study of 63 patients. Acta Orthop, 2007, 78:193-200.
  • 9Luber M J, Greengrass R, Vail TP. Patient satisfaction and effectiveness of lumbar plexus and sciatic nerve block for total knee arthroplasty. J Arthroplasty, 2001, 16: 17-21.
  • 10Rooke GA, Freund PR, Jacobson. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease[J]. Anesth Analg, 199785(1): 99-105.

共引文献30

同被引文献49

二级引证文献40

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部