超声联合神经刺激器引导腰丛神经阻滞在肥胖患者下肢手术麻醉中的应用

Ultrasound combined with neurostimulation-guided lumbar plexus block in obese patients

目的研究超声联合神经刺激器引导提高肥胖患者下肢手术腰丛神经阻滞麻醉成功率。方法选择本院2016年6月至2018年6月下肢手术需行腰丛神经阻滞麻醉的肥胖患者80例,分为超声组(U组,n=40)和超声联合神经刺激器定位组(UN组,n=40)。观察两组超声成像及阻滞效果。结果 U组超声成像评分为11(6～15)分,26例患者可见腰丛神经;UN组超声成像评分为11(5～15)分,23例患者可见腰丛神经,两组差异无统计学意义(P>0.05)。U组31例成功阻滞,9例阻滞失败;UN组38例成功阻滞,2例阻滞失败,UN组阻滞成功率明显优于U组(P<0.05)。结论超声联合神经刺激器应用于肥胖患者的腰丛神经阻滞可以弥补超声成像不佳,提高阻滞成功率。

Objective To assess the efficacy of ultrasound combined with neurostimulation for improving the success rate of lumbar plexus block in obese patients undergoing lower extremity surgeries.Methods We randomized 80 obese patients undergoing lower limb surgeries under lumbar plexus block anesthesia between June,2016 and June,2018 into 2 equal groups,in which lumbar plexus block was performed under ultrasound localization(U group)or ultrasound combined with neurostimulation localization(UN group).The findings by ultrasound imaging and the success rate of lumbar plexus were compared between the 2 groups.Results All the 80 patients completed the study.In the U group,the ultrasound visibility score was 11(range 6-15),and the lumbar plexus was seen in 26 patients;The ultrasound visibility score of the UN group was 11(5-15),and the lumbar plexus was observed in 23 patients,showing no significant differences between the two groups(P>0.05).In the U group,lumbar plexus block was achieved successfully in 31 cases and failure occurred in 9 cases;successful block was achieved in 38 cases and failure occurred in 2 cases in the UN group,demonstrating a significantly higher success rate in the latter group(P<0.05).Conclusion Ultrasound combined with neurostimulation can improve the success rate of lumbar plexus block in obese patients.