高龄患者下肢手术行外周神经阻滞效果分析

The anesthesia effect of peripheral nerve block in lower limb surgeries in the aged

目的：在老年患者下肢手术过程中分别采用硬膜外麻醉与外周神经阻滞两种方法，并观察这两种麻醉方法的麻醉效果和安全性。方法选取2013年1月~2014年1月因下肢外伤就诊于我院的老年患者24例。按随机分组的方法分为外周神经阻滞组和硬膜外麻醉组，每组12例。外周神经阻滞组：在神经刺激器引导下行后路腰丛及坐骨神经阻滞。硬膜外麻醉组常规硬膜外麻醉。结果两组手术麻醉效果无显著差异（P＞0.05）。血流动力学改变：外周神经阻滞组患者阻滞前后及术毕均无明显波动，麻醉后15，30min两组心率、收缩压、舒张压及平均动脉压均有显著差异（P＜0.05）。镇痛时间：外周神经阻滞组明显长于硬膜外阻滞组。外周神经阻滞组起效时间明显短于硬膜外阻滞组，差异有统计学意义（P＜0.05）。外周神经阻滞组维持时间长于硬膜外阻滞组，差异有统计学意义（P＜0.05）。运动神经阻滞：外周神经阻滞组起效时间、维持时间均短于硬膜外阻滞，差异有统计学意义（P＜0.05）。结论外周神经阻滞可安全有效地应用于80岁以上高龄老人下肢手术。

ObjectiveTo observe the anesthesia effect and safety of two methods（peripheral nerve block and epidural anesthesia） in lower limb surgeries in the aged.MethodsFrom January 2013 to January 2014, 24 patients who came to our hospital because of trauma of lower limb was selected. Randomized grouping design was used. The 24 patients were randomly divided into 2 groups： Peripheral nerve-block group and epidural anesthesia group. Peripheral nerve-block group： Combined lumber plexus-sciatic nerve block was performed by nerve stimulator.Results It showed no significant difference in the anesthesia effect between two groups （P〉0.05）. Hemodynamics： There were no obvious fluctuation before and after block and at the end of surgery in the peripheral nerve block group. The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure of the two groups at 15 and 30 minutes after block were obviously different（P〈0.05）. Analgesia time： It was obviously longer in the peripheral nerve block group than in the epidural anesthesia group（P〈0.05）. Sensory block： The onset time, sufficient time in the peripheral nerve block group were obviously shorter than those in the epidural anesthesia group, and the duration was longer than that in the epidural anesthesia group（P〈0.05）. Motor block： The duration was shorter in the peripheral nerve block group than in the epidural anesthesia group（P〈0.05）.ConclusionIt showed no significant difference in the ana esthesia effect between peripheral nerve block and epidural anesthesia. Peripheral nerve block is safe and effective for lower limb operation in the aged.