超声引导下股神经联合胭窝入路坐骨神经阻滞在老年人膝关节以下手术中的应用

Clinical application of the femoral nerve combined with popliteal fissure sciatic nerve block in eiderly patients with below knee surgery

目的探讨超声引导下股神经联合胭窝入路坐骨神经阻滞在老年人膝关节以下手术的临床应用效果。方法选取行膝关节以下手术的老年患者94例，随机分为观察组和对照组，每组47例。观察组给予超声引导下股神经联合胭窝入路坐骨神经阻滞，对照组给予腰硬联合麻醉，比较两组患者麻醉操作时间、感觉神经阻滞时间、运动神经阻滞时间，麻醉前，麻醉后15、30、60min平均动脉压（MAP）、心率（Ha）、麻醉效果及不良反应发生情况。结果观察组麻醉操作时间、感觉神经阻滞[麻醉起效时间（T1）、麻醉持续时间（T3）]较对照组显著延长，感觉神经阻滞[麻醉完善时间（T2）]、运动神经阻滞（T1、12、13）较对照组显著缩短，差异均有统计学意义（P〈0．05），麻醉前两组患者MAP、HR比较差异未见统计学意义（P〉0．05），麻醉后15、30、60min对照组患者MAP较观察组患者显著降低，差异有统计学意义（P〈0．05），两组患者HR比较差异未见统计学意义（P〉0．05），观察组、对照组麻醉效果优良率分别为100％、95．74％，比较差异未见统计学意义（P〉0．05），观察组不良反应发生率（4．26％）较对照组（21．28％）显著降低，差异有统计学意义（P〈0．05）。结论超声引导下股神经联合胭窝入路坐骨神经阻滞应用于老年人膝关节以下手术，麻醉效果好，操作方便，患者生命体征稳定，不良反应少，值得临床广泛推广。

Objective To investigate the clinical application of ultrasound-guided femoral nerve combined with popliteal fissure sciatic nerve block in elderly patients with below knee surgery. Methods A total of 94 cases of elderly patients undergoing surgery under knee joint were randomly di- vided into observation group and control group, with 47 cases in each group. The patients in the observa- tion group underwent ultrasonography-guided femoral nerve combined with popliteal fossa sciatic nerve block, and the patients in the control group received lumbar and spinal combined anesthesia. The mean arterial pressure, heart rate, anesthesia effect and adverse reaction were observed before and after anes- thesia at 15, 30 and 60 min after anesthesia, the time of anesthesia operation, the time of sensory nerve block, the time of motor nerve block were compared between the two groups. Results The time of anes- thesia operation and sensory nerve block （T1, T3） in the observation group were significantly longer than those in the control group, and the sensory nerve block （T2） and motor nerve block （T1, T2, T3 ） were significantly shorter than those in the control group, and the differences were statistically significant （P 〈 0. 05 ）. There was no significant difference in MAP and HR between the two groups before anesthe- sia （P 〉 0. 05）. The MAP in the control group was significantly lower than that in the observation group at 15, 30 and 60 rain after anesthesia, and the difference was statistically significant （P 〈 0. 05 ）. There was no significant difference in HR between the two groups （ P 〉 0. 05 ）. The excellent and good rate of anesthesia in the observation group and the control group were 100% and 95.74% respectively. There was no significant difference （ P 〉 0. 05 ）. The incidence of adverse reactions in the observation group （4. 26% ）was significantly lower than that in the control group（21.28% ）, and the difference was statis- tically significant （P 〈 0. 05 ）. Conclusions Ultrasound-guided femoral nerve combined with popliteal fissure sciatic nerve block in the elderly below knee surgery has good anesthesia effect. The operation is convenient, the patient＇s vital signs are stable and the adverse reaction is small, and it is worthy to be widely popularized in the clinic.