腰丛-坐骨神经阻滞用于股骨上段手术麻醉的临床观察

A CLINICAL STUDY ON COMBINED LUMBAR PLEXUS-SCIATIC NERVE BLOCK WITH ROPIVACAINE IN PATIENTS UNDERGOING UPPER FEMUR SURGERY

目的观察腰丛一坐骨神经阻滞用于股骨上段手术麻醉镇痛、肌松效果及对血流动力学的影响。方法选择行单侧股骨上段手术患者40例，随机分成两组：神经刺激器引导下腰丛一坐骨神经阻滞麻醉组（L组，n=20）和硬外神经阻滞麻醉组（E组，n=20）；两组麻醉用药分别是1％利多卡因＋0．375％罗比卡因混合液30～35ml和0．75％罗比卡因15-20ml。分别记录麻醉前、麻醉后2min、10min、15min、30min收缩压、舒张压、平均压、心率和麻醉后SBP下降达麻醉前30％的病例数；针刺疼痛消失时间；改良Bromage法肌肉松弛评分。结果两组间各对应时点和各组内麻醉前、后各时点血流动力学变化无显著性差异（P〉0．05）；血压降低大于麻醉前30％者：L组4例，E组5例；疼痛消失时间：L组明显短于E组（P〈0．05）；Bromage评分：L组低于E组（P〈0.05）。结论腰丛一坐骨神经阻滞用于股骨上段手术麻醉具有镇痛起效快、对血流动力学影响小，但肌松效应差。

Objective To evaluate the effect of analgesia, muscular relaxation and hemodynamic responses of combined lumbar plexus - sciatic nerve block with ropivacaine in 40 patients undergoing upper femur surgery. Methods 40 patients, ASA physical status of Ⅰ - Ⅱ grade, undergoing upper femur surgery were randomly allocated into two groups： group L（ n = 20） and E （n = 20）. In group L, combine lumber plexus -sciatic nerve block was performed guided by a nerve stimulator （2Hz of stimulation frequency and 0.5 - 2.5 mA of currency）. Subsequently, the mixture liquid of 1% lidocaine and 0. 375% ropicvaaine 30 - 35 ml was injected over there. Then sciatic nerve block was performed with that liquid 15 nil. In group E, epidural anesthesia was performed at Lz -3 or L3 -4 interspaces with 0. 75% ropivacaine 15 ml-20 ml. The systolic, diastolic, mean arterial blood pressure, and heart rate were measured before anesthesia, and at 2,10,15,30 min after anesthesia, the effect of muscular relaxation was recorded by Bromageg method and the onset time of analgesia, the case that decreased over 30% value of the systolic blood pressure were recorded in the two groups respectively. Results The hemodynamic changes at the different points have no significance in the two groups. In group L , the onset time of analgesia was faster than that in group E, there was significant difference（P 〈0. 05）. The Bromageg score in group L was significantly ]Lower than that in group E（P 〈 0. 05）. The cases that systolic blood pressure decreased over 30% were 4 and 5 in group L and E respectively. Conclusion Combined lumbar plexus - sciatic nerve block with ropivacaine for upper femur surgery had rapid onset of analgesia and stable hemodynamics, but the effect of muscular relaxation was not good in that operations.