联合神经阻滞与硬膜外麻醉用于老年单侧全髋关节置换术的比较

Compare the effects of combined nerve block and epidurai anesthesia in elderly patients undergoing unilaternal total hip replacement surgery

目的 比较腰丛-坐骨神6经阻滞与硬膜外麻醉在老年单侧全髋关节置换术中的麻醉效果.方法 择期行单侧全髋关节置换术的老年患者42例,按随机数字表法分为腰丛-坐骨神经阻滞组（N组）和硬膜外麻醉组（EA组）,每组各21例.N组采用神经刺激仪定位,腰丛和坐骨神经分别注入1%利4多卡因15 ml和0.5%罗哌卡因20 ml及1%利多卡因5 ml和0.5%罗哌卡因20ml;EA组给予0.5%罗哌卡因10～15 ml.记录两组患者的血流动力学变化,感觉、运动神经阻滞起效时间、持续时间及术后并发症.结果 麻醉后10、20、30、60 min EA组的收缩压和舒张压均明显低于麻醉前和N组同一时间点（P＜0.05）.两组患者感觉和运动神经阻滞起效时间相近（P＞0.05）,但N组感觉和运动神经阻滞持续时间[（436.5±103.3）、（307.3±112.4）min]长于EA组[（305.2±110.8）、（189.3±84.5）min]（P＜0.05）.术后EA组有4例出现恶心呕吐症状,N组无恶心呕吐发生.结论 腰丛-坐骨神经阻滞用于老年单侧全髋关节置换术阻滞完善,血流动力学稳定,作用时间长,术后并发症少.

Objective To compare the effects of combined lumbar plexus-sciatic nerve block and epidural anesthesia in elderly patients undergoing unilatemal total hip replacement surgery. Methods Fortytwo patients were randomly divided in two groups （each in 21 cases）,combined lumbar plexus-sciatic nerve block group （group N） and epidural anesthesia group （group EA）. In group N, combined lumbar plexussciatic nerve block guided by a nerve stimulator was conducted,with 1% lidocaine 15 ml and 0.5% ropivacaine 20 ml （lumbar plexus） and 1% lidocaine 5 ml and 0.5% ropivacaine 20 ml （sciatic nerve）. In group EA,epidural anesthesia was achieved by injection of 0.5% ropivacaine 10-15 ml. The variations in hemodynamics, the effect of never block and adverse reactions in both groups were recorded. Results The blood pressure was decreased significantly in group EA than that in group N at 10,20,30,60 min after epidural anesthesia （P 〈0.05）. There was no difference in the onset time of sensory and motor blockade between two groups （P 〉0.05）,while the duration of sensory and motor blockade was longer in group N [（436.5 ± 103.3 ）, （ 307.3 ± 112.4 ） min ] than those in group EA [ （305.2 ± 110.8）, （ 189.3 ± 84.5 ） min ]（P 〈 0.05）. There was 4 patients combined nausea and vomiting in group EA. Conclusion Combined lumbar plexus-sciatic nerve block in elderly patients undergoing unilaternal total hip replacement surgery has stable hemodynamics, longer analgesia duration and fewer adverse reactions.