神经刺激仪引导下腰丛神经+坐骨神经阻滞在股骨粗隆间骨折手术中应用的优缺点

Advantages and Disadvantages of Application of Sciatic Nerve Block and Lumbar Plexus Block Guided by Neurostimulator in Intertrochanteric Fracture Operation

目的:探讨神经刺激仪引导下腰丛神经+坐骨神经阻滞在股骨粗隆间骨折手术中应用的优缺点。方法:选取2016年1月-2017年10月本院收治的60例股骨粗隆间骨折患者临床资料进行分析。依据不同麻醉方式随机分为A组(坐骨神经阻滞+腰丛神经阻滞)与B组(腰硬联合麻醉),每组30例。比较两组术前与术后10、20、30、45 min血流动力学变化情况以及麻黄碱使用情况、麻醉操作时间、镇痛效果、肌松效果。结果:A组股骨粗隆间骨折患者术前与术后10、20、30、45 min的SBP、DBP、P、Sp O2均优于B组,差异均有统计学意义(P<0.05)。A组麻黄碱使用率低于B组,麻醉操作时间长于B组,差异均有统计学意义(P<0.05)。A组镇痛优良率低于B组,差异有统计学意义(x^2=10.87,P<0.05)。A组肌松效果差于B组,差异有统计学意义(Z=10.28,P<0.05)。结论:坐骨神经阻滞+腰丛神经阻滞在股骨粗隆间骨折患者中应用,对于患者血流动力学影响较小、神经损伤概率和使用麻黄碱概率较低,影响体内生理功能较小,手术患者年纪越大,基础疾病越多,值得临床推广应用。

Objective：To discuss the advantages and disadvantages of application of sciatic nerve block and lumbar plexus block guided by neurostimulator in intertrochanteric fracture operation.Method：A total of 60 cases with intertrochanteric fracture in our hospital from January 2016 to October 2017 were divided into group A（sciatic nerve block＋lumbar plexus block）and group B（combined spinal-epidural anesthesia）according to different anaesthesia methods,30 cases in each group.The hemodynamic change before operation and after operation 10,20,30,45 min,the using Ephedrine and anaesthetic operation time,the analgesic effect and the muscle relaxation were compared between the two groups.Result：SBP,DBP,P,SpO2 of the hemodynamic change before operation and after operation 10,20,30,45 min in group A were better than those in group B,the differences were statistical significance（P〈0.05）.The using Ephedrine rate in group A was lower than that in group B,and the anaesthetic operation time in group A was longer than that in group B,the differences were statistical significance（P〈0.05）.The analgesic effect in group A was lower than that in group B,the difference was statistical significance（ χ2=10.87,P〈0.05）.The muscle relaxation in group A was worse than that in group B,the difference was statistical significance（Z=10.28,P〈0.05）.Conclusion：The application of sciatic nerve block and lumbar plexus block guided by neurostimulator have less effect on haemodynamics and physiological function,low probability in nerve injury,low rate of using Ephedrine on patients with intertrochanteric fracture,it is worthy of clinical application.