超声引导股骨近端一针两点技术在老年膝关节以下手术的应用

Application of ultrasound-guided single-penetration dual-injection block in elderly surgery under knee

目的探讨超声引导股骨近端一针两点（single-penetration dual-injection，SPEDI）技术用于老年膝关节以下手术的安全性、便捷性、有效性。方法选择行膝关节以下手术的老年患者80例，按随机数字表法分为两组（每组40例）：SPEDI技术组（A组）、胭窝坐骨神经联合隐神经阻滞组（B组）。超声引导下使用0．5％盐酸罗哌卡因20ml和5ml行坐骨神经及隐神经阻滞，记录两组摆体位时间，阻滞操作时间和总操作时间，入室给予镇静药后（T0）、操作时（T1）、切皮时（T2）、手术结束时（T3）的SBP、DBP和HR。评估注药后10、20、30min时感觉阻滞、运动阻滞及术中使用舒芬太尼情况。结果A组摆体位时间、阻滞操作时间和总操作时间显著短于B组（P〈0．05）；操作时A组血流动力学指标比B组平稳（P〈0．05）；腓肠神经在注药后20、30min，胫神经在注药后30min的感觉阻滞B组高于A组（P〈0．05）；运动阻滞及术中舒芬太尼需要量组间差异无统计学意义（P〉0．05）。结论SPEDI技术在老年膝关节以下手术中操作便捷、安全、有效，值得在临床上广泛推广。

Objective To discuss the safety, effectiveness and convenience of the single-penetration dual-injection（SPEDI） method using in elderly patient surgery under knee joint. Methods Eighty cases of elderly patients who have the surgery below the knees were randomly divided into two groups, SPEDI group（group A） and popliteal fossa sciatic nerve combined with saphenous nerve block group （group B）. Using 0.5% ropivacaine 20 ml and 5 ml with sciatic nerve and saphenous nerve block. The operation time of two groups, burglary given sedative （T0）, operation time （T1）, skin incision （T2）, operation at the end of the contraction pressure（T3）, diastolic blood pressure and heart rate were recorded. Sensory and motor blockade after the injection of 10, 20, 30 rain and the amount of sufentanil needed in surgery were evaluated and recorded. Results The block execution time of group A was significantly shorter than group B （P〈0.05）. The hemodynamics of group A was more stable than group B during operation （P〈0.05）. There was significant difference in the rate of sensory block （P〈0.05） within 50 min within two groups. There was no difference on motor block effect and sufentanil needed （P〉0.05）. Conclusions SPEDI method is convenient, safe and effective in elderly surgery under knee joint. It is worth to be widely used in clinical practice.