腰丛-坐骨神经联合阻滞用于老年患者下肢手术的临床研究

Combined lumbar plexus and sciatic nerve block in elderly patients undergoing lower limb operations

目的探讨腰丛-坐骨神经联合阻滞在老年患者下肢手术应用的可行性。方法40例60岁以上拟行单侧下肢手术的患者随机均分为两组。A组采用神经刺激器定位技术,正确定位腰丛和坐骨神经后分别给予0.375%罗哌卡因20～25ml和0.5%罗哌卡因15～20ml;B组选择L2～3或L3～4间隙行硬膜外麻醉,给予0.75%罗哌卡因10～15ml。观察两组血流动力学变化、阻滞效果及其不良反应。结果B组麻醉15min后各时点的SBP、DBP均明显低于麻醉前及A组(P<0.05或P<0.01);A组镇痛持续时间长于B组(P<0.05),但运动阻滞持续时间短于B组(P<0.05);B组术中使用麻黄碱的例数及输液量高于A组(P<0.05);B组患者围术期恶心、呕吐、尿潴留等不良反应的发生率明显高于A组(P<0.01)。结论腰丛-坐骨神经联合阻滞对血流动力学影响小,术后镇痛时间长,并发症少,适用于老年患者下肢手术。

Objective To investigate the feasibility of combined lumbar plexus and sciatic nerve block in elderly patients undergoing lower limb operations. Methods Forty elderly patients （〉60 years old） were randomly divided into two groups with 20 cases each. Combined lumbar plexus and sciatic nerve block guided by nerve stimulator was used in group A with 0. 375% ropivacaine 20-25 ml and 0. 5 % ropivaeaine 15 20 ml, respectively,and epidural anesthesia with 0.75% ropivacaine 10-15 ml in group B. The change of hemodynamics, the effect of nerve block and adverse reactions were recorded. Results SBP and DBP were significantly lower in group B than those in group A 15 min after injection of local anesthetics （P〈0.05 or P（0. 01 ）. The duration of analgesia was longer and of motor Block was shorter in group A than those in group B （P〈0.05）. The incidence of nausea, vomiting and urinary retention was higher in group B than that in group A （P〈0.01）. Conclusion Combined lumbar plexus-sciatic nerve block is suitable to the ealderly undergoing lower limb procedures with a longer analgesia,less effect on hemodynamics and fewer complicatioris.