超声引导腰丛-坐骨神经阻滞在老年患者单侧下肢手术中的应用

Value of ultrasound-guided lumbar plexus-sciatic nerve block anesthesia in elderly patients undergoing lower limb surgery

目的探讨老年患者单侧下肢手术中超声引导腰丛-坐骨神经阻滞的应用价值。方法选择2015年7月至2017年7月期间东莞市长安医院收治的120例老年单侧下肢手术患者为研究对象,根据随机数表法将患者分为对照组和观察组,每组60例,对照组患者予腰硬联合麻醉,观察组患者应用超声引导下腰丛-坐骨神经阻滞麻醉,比较两组患者术中不同时间点[穿刺前(T0)、注完麻醉药后的15 min(T1)、60 min(T2)、90 min(T3)]的收缩压(SBP)、舒张压(DBP)及心率(HR)的变化,以及神经的阻滞起效时间、维持时间和不良反应发生情况。结果对照组患者麻醉后T1、T2、T3时点的SBP、DBP均明显低于观察组,差异具有统计学意义(P<0.05);两组患者的HR均无明显变化(P>0.05);观察组患者的运动及感觉神经阻滞起效时间分别为(9.8±2.9)min和(6.1±1.7)min,均明显短于对照组的(14.3±5.4)min和(10.2±4.8)min,运动及感觉神经维持时间分别为(343.1±64.1)min和(474.5±82.6)min,较对照组的(265.7±50.2)min和(350.4±61.5)min明显延长,差异均有统计学意义(P<0.05);观察组患者的总不良反应发生率为5.0%,明显低于对照组的18.3%,差异有统计学意义(P<0.05)。结论超声引导腰丛-坐骨神经阻滞应用于老年患者单侧下肢手术具有血流动力学稳定的优点,且起效迅速,麻醉效果好,不良反应少。

Objective To evaluate the value of ultrasound-guided lumbar plexus-sciatic nerve block anesthesia in elderly patients undergoing lower limb surgery. Methods From July 2015 to July 2017, 120 elderly patients undergoing lower limb surgery in Dongguan Chang＇an Hospital were selected and divided into observation and control group according to random number method, with 60 patients in each group. The control group was given combined spinal epidural anesthesia, while the observation group applied ultrasound-guided lumbar plexus-sciatic nerve block anesthesia. At different time points（before puncture [T0], 15 min [T1], 60 min（T2）, 90 min（T3） after injection of anesthetics）, changes of systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR）, the onset time, maintenance time, and adverse reactions of the nerve block were compared between the two groups. Results At T1,T2, T3, SBP and DBP in the control group were significantly lower than those in the observation group（P〈0.05）, while HR in the two groups were of no significant difference（P〈0.05）. Motor and sensory block onset time in observation group was（9.8±2.9） min and（6.1±1.7） min, significantly shorter than（14.3±5.4） min and（10.2±4.8） min in the control group. Motor and sensory maintain time was（343.1 ± 64.1） min and（474.5 ± 82.6） min in observation group, as compared with（265.7 ± 50.2） min and（350.4±61.5） min in the control group（P〈0.05）. The adverse reaction rate in the observation group（5.0%） was significantly lower than that in the control group（18.3%）, P〈0.05. Conclusion Ultrasound-guided lumbar plexus-sciatic nerve block anesthesia has the advantage of hemodynamic stability in elderly patients undergoing lower limb surgery,with rapid onset, good anesthetic effect, and lower adverse reactions rate.