腰丛-坐骨神经阻滞应用于老年病人下肢手术

A clinical trial of combined lumbar plexus and sciatic nerve block for senile patients

目的：比较腰丛-坐骨神经联合阻滞和硬膜外麻醉对老年病人血液动力学的影响及术后的不 良反应。方法：择80例临床拟行单侧下肢手术的老年病人，随机分为腰丛-坐骨神经阻滞组(A 组，n=40) 和硬膜卟麻醉(B，n=40) 两组，分别施行腰丛-坐骨神经阻滞和硬膜外麻醉。A 组腰丛和坐骨神经阻滞采 用神经刺激器定位技术，两点分别给予0． 4%罗比卡因0． 3 ml/kg(坐骨神经)、0． 5 ml/kg(腰丛)：B 组则 选择L2～3或L3～4间隙行硬膜外麻醉，予0． 75%罗比卡因0． 3ml/kg。记录麻醉前、麻醉后15、 30、 60、 90 min 的收缩压(SBP)、舒张压(DBP)和心率(HR)，升压药的用量、术中输液量、尿潴留发生率等并 记录病人麻醉及术后的不良反应，感觉神经阻滞起效及恢复时间。结果：与麻醉前比较，两组病人麻醉 后的血压均显著下降，B 组病人在麻醉后15 min、30min 的 SBP、DBP 明显低于 A 组(P＜0． 01) ，随后 60 min 及90min 的 DBP 仍明显低于 A 组(P＜0． 05) ；手术期间 B 组的晶体输入量(1425±361) ml 明显高 于 A 组(1010±329) ml(JP＜0． 01) 。曾用麻黄碱针的病人 B 组(16例)显著多于 A 组(1例)(P＜0． 05) 。 B 组尿潴留发生率(11/40例)显著高于 A 组(0/40例)(P＜0． 01) 。结论：应用神经刺激器定位技术下 行腰丛-坐骨神经联合阻滞对血流动力学影响小，不良反应少，是老年病人行下肢手术理想的麻醉选择。

Objective： To compare the hemodynamic responses and postoperative complication of combined lumbar plexus and sciatic nerve block and epidural anesthesia in the senile patients. Methods： Eighty senile patients, ASA physical status of Ⅰ-Ⅲ, undergoing lowerextremity surgery were randomly divided into two groups： lumbar plexus and sciatic group （A） （n=40） and epidural group （B） （n=40）. In group A, patients were assigned to receive lumbar plexus block using 0.5 ml/kg of ropivacaine 0.4% and sciatic nerve block using 0.3 ml/kg of ropivacaine 0.4%. In group B, epidural anesthesia was performed at L2-3 or L3-4 interspace with 0.75% ropivacaine 0.3 ml/kg. The systolic and diastolic blood pressure, and heart rate were measured before anesthesia, 15, 30, 60 and 90 min after anesthesia, the volume of fluid infusion and postoperative complications were recorded. Results： The systolic and diastolic blood pressure after anesthesia decreased significantly than that before anesthesia in both group. The systolic and diastolic blood pressure decreased significantly in group B than that in group A at 15, and 30 min after anestbesia; so was the diastolic blood pressure at 60, and 90 min after anesthesia （P〈0.05）. The volume of fluid infusion in group B was more than that in group A（P〈 0.01）. The urine retention was significantly fewer in group A than that in group B. Conclusion： Nerve stimulator-assisted lumbar plexus and sciatic nerve block is a good choice for senile patients undergoing lower-extremity surgery with a stable hemodynamics and fewer complication.