右美托咪定辅助腰丛联合坐骨神经阻滞麻醉在单侧下肢骨科手术中的应用

Application of lumbar plexus-sciatic nerve block combined with intravenous sedative anesthesia with dexmedetomidine in the orthopedic surgery of unilateral lower limb

目的:探讨右美托咪定辅助腰丛联合坐骨神经阻滞麻醉在单侧下肢骨科手术中的麻醉效果和安全性。方法:选取择期行单侧下肢骨科手术患者50例为研究对象,随机分为右美托咪定辅助腰丛联合坐骨神经阻滞麻醉组(N组),右美托咪定辅助连续硬膜外麻醉组(E组),各25例,记录两组患者在入室后麻醉穿刺前(T_0)、麻醉阻滞后10 min(T_1)、20 min(T_2)、30 min(T_3)、手术开始切皮时(T_4)、手术开始后30 min(T_5)、手术结束时(T_6)的SBP、DBP及HR;记录两组阻滞完成时间、感觉阻滞起效时间、术后感觉阻滞失效时间、术中血管活性药使用情况、麻醉效果;记录术后2 d内恶心、呕吐、头痛及尿潴留发生情况。结果:T_3时N组的SBP、DBP明显高于E组(P<0.05);与T_0时比较,T_3时E组的SBP、DBP明显降低(P<0.05),T_1~T_6时两组HR明显降低(P<0.05);两组患者阻滞完成时间、感觉阻滞起效时间及阻滞失效时间比较,N组均明显长于E组(P<0.05);两组患者麻醉效果优、良、差的比例差异无统计学意义(P>0.05);N组术中血管活性性药使用率(0%)明显低于E组(32.0%)(P<0.05)。术后2d内,N组尿潴留发生率明显低于E组(P<0.05),两组恶心、呕吐及头痛发生率差异无统计学意义(P>0.05)。结论:右美托咪定辅助腰丛联合坐骨神经阻滞用于单侧下肢骨科手术中,麻醉效果良好,较硬膜外阻滞具有血流动力学影响小,术后并发症少及适应证更广等优点。

Objective To investigate the clinical effect and security of lumbar plexus-sciatic nerve block combined with intravenous sedative anesthesia with dexmedetomidine in the orthopedic surgery of unilateral lower limb. Method Fifty patients scheduled for unilateral lower extremity surgery were randomly selected as the research object,they were divided into two groups：lumbar plexus-sciatic nerve block combined with intravenous sedative anesthesia with dexmedetomidine group（group N） and epidural anesthesia combined with intravenous sedative anesthesia with dexmedetomidine group（group E）,25 cases in each group. The blood pressure and heart rate of patients before anesthesia（T0）,10 min（T1）,20 min（T2）,30 min（T3） after the never block anesthesia,the beginning of the operation（T4）,30 min（T5） after cutting skin,the end of the operation（T6） were recorded. The block working time and onset time and lose efficacy time of sensory block,use of vasoactive drug after anesthesia,anesthesia efficacy and the postoperative adverse reactions in the last two days,including nausea,vomiting,headache and urinary retention,were also recorded. Results Compared with T0,the SBP and DBP was significantly decreased at T3 in group E（P〈0. 05） and the HR was also signidicantly decreased at T1 to T6 in the both groups（P〈0. 05）. Compared with group E at the same time,the SBP and DBP was significantly higher at T3 in group N（P〈0. 05）. The block working time and onset time and lose efficacy time of sensory block was significantly lengthened in group N（P〈0. 05）. But the use of vasoactive drug after anesthesia and the incidence of postoperative urinary retention were significantly decreased in group N（P〈0. 05）. And there was no significant difference in the whole anesthesia dfficacy and the rate of nausea,vomiting and headache（P〈0. 05）. Conclusion-Lumbar plexus-sciatic nerve block combined with intravenous sedative anesthesia with dexmedetomidine has excellent anesthetic quality in the orthopedic surgery of unilateral lower limb,which ensures more stable hemodynamics less side effects and more indications when compared with epidural anesthesia.