神经刺激器定位下腰丛-坐骨神经联合阻滞在老年患者股骨头置换中的应用

Application of lumbar plexus and sciatic nerve block in femur head surgery of aged patients by nerve stinulator

目的探讨神经刺激器定位下的腰丛-坐骨神经联合阻滞麻醉在老年患者股骨头置换手术中麻醉效果。方法选择择期行单侧股骨头置换手术的老年患者56例,年龄>65岁,ASAⅠ～Ⅲ级,随机分为两组,神经阻滞组(N组)和硬膜外阻滞组(E组),每组28例,在麻醉前(T1),麻醉后(T2),手术开始时(T3),手术结束时(T4),记录MAP、HR、SpO2、麻醉效果以及不良反应。结果 56例患者均阻滞完善,麻醉效果满意,两组患者的MAP在麻醉前(T1)和手术结束时(T4)差异无统计学意义(P>0.05),硬外阻滞组患者的MAP在麻醉后(T2)和手术开始时(T3)显著低于神经阻滞组(P<0.05)。两组患者的HR和SpO2在各时点均无显著差异(P>0.05)。结论神经刺激器定位技术下腰丛-坐骨神经联合阻滞应用于老年患者股骨头置换手术是安全有效的,对血流动力学影响小,不良反应少。

Objective To evaluate the anesthesia efficacy of lumbar plexus combined with sciatic nerve block by peripheral nerve stimulator（PNS） for the aged undergoing unilateral femur head surgery.Methods fifty-six aged patients undergoing unilateral femur head surgery,in ASA Ⅰ~Ⅲ grade,were randomly divided into two groups with 28 cases in each group.Lumbar plexus and sciatic nerve block by PNS were used in group N,while epidural anesthesia was used in group E.MAP,HR and SpO2of the two groups were monitored in preanesthesia（T1）,postanesthetic（T2）,stare of operation（T3） and end of operation（T4）.And the anesthesia efficacy and adverse reaction were recorded.Results All patients in two groups had satisfactory anesthesia.The MAP were not significantly difference between group N and group E in T1 and T4.In T2 and T3,the MAP of group E was lower than group N significantly.The HR and SpO2of two groups were not significantly difference in all time.Conclusion Lumbar plexus and sciatic nerve block by PNS is safe and effective for the aged undergoing unilateral femur head surgery for its less effects on hemodynamics,fewer adverse reaction,long time of analgesia and early recovery.