股神经联合坐骨神经阻滞麻醉与蛛网膜下腔阻滞麻醉在膝关节镜手术中的麻醉效果比较

The Comparison of Anesthesia Effect of Femoral Nerve Block Combining Sciatic Never Block with the Anesthetic Effect of Subarachnoid Block in the Knes Arthroscopy Operations

目的 对神经刺激器辅助下股神经联合坐骨神经阻滞麻醉与蛛网膜下腔阻滞麻醉在膝关节镜手术中的麻醉效果进行比较。方法 60例ASAⅠ～Ⅱ级行膝关节镜检查的患者60例,随机分成两组,蛛网膜下腔阻滞组（C组）和下肢神经阻滞组（N组）,蛛网膜下腔阻滞组于蛛网膜下腔给予0.5%罗哌卡因轻比重液3m L。下肢神经阻滞组采用神经刺激器辅助下股神经联合坐骨神经阻滞,局麻药采用浓度为0.5%的罗哌卡因。股神经阻滞剂量为20m L,坐骨神经阻滞剂量为30m L。记录并比较两组患者的血流动力学指标、麻醉起效与维持时间、麻醉效果、术中是否追加辅助用药等。结果两组患者血流动力学比较,C组与N组相比,麻醉后5min（T5）MAP下降,10min（T10）MAP下降差异有统计学意义（P〈0.05）。C组感觉完全阻滞时间（T1）、运动完全阻滞时间（T2）、感觉完全消退时间（T3）、运动完全消退时间（T4）、低于N组（P〈0.05）。C组术后首次排尿时间（TU）长于N组（P〈0.05）。结论 超声引导下股神经联合坐骨神经阻滞效果确切,血流动力学平稳,是膝关节镜手术一种值得推广的麻醉方式。

Objective To compare the efficacy combined of femoral/sciatic nerve block using peripheral nerve stimulator and spinal-epidural anesthesia in the arthroscopic knee surgery. Methods Sixty patients undernent arthroscopic knee surgery were randomly divided into two groups, thirty in each group： group C （ combinedspinal-epidural anesthesia group）, group N （ combined femoral/sciatic nerve block）. Patients in group C received spinal anesthesia and epidural catheter. The local anesthet- ic drug was 0.5% isobaric ropivacaine 3 ml Patients in group N received femoral/sciatic nerve block using peripheral nerve stim- ulator. The local anesthetic drug was 0. 5% isobaric ropivacaine, and the amount of the drug for femoral nerve block was 20 ml and 30 ml for sciatic nerve block. The hemodynamics, onset time, duration time and efficacy of anesthesia were recorded. Results The mean artery （MAP）, heart rate （HR） of Ts（5 minutes after anesthesia ） and T10 in group C were decreased than that in group N （ P 〈 0. 05 ）. T1 （ The onset time of sensory block）, T 2 （ The onset time of motor block）, T3 （ The onset time of sensory recovery） and T4 （ The onset time of motor recovery） of group C were shorter than those of group N （P 〈 0. 05 ）. The Tu（ The flint time of urine postoperation） of group C was longer than group N （ P 〈 0. 05 ）. Conclusion The anesthetic stragegy of femoral/ sciatic nerve block using peripheral nerve stimulator would be raised and it would lead to complete blockade, stable hymodynanics.