超声引导下穿刺定位行腰丛-坐骨神经阻滞麻醉在高龄人工膝关节置换术中的应用效果

Application effect of ultrasound-guided puncture lumbar plexus-sciatic nerve block in artificial knee replacement for the elderly

目的探讨超声引导下穿刺定位行腰丛-坐骨神经阻滞麻醉在高龄人工膝关节置换术中的应用效果。方法选取2015年4月～2017年2月我院收治的80例高龄人工膝关节置换术患者作为研究对象,随机分为研究组和对照组,每组各40例。研究组采用在超声引导下穿刺定位下行腰丛-坐骨神经阻滞麻醉,对照组采取硬膜外麻醉,比较两组患者麻醉的起效和维持时间,术中出血量、补液量、术后引流量和恢复饮食时间、术中心率和平均动脉压、麻醉后的不良反应等。结果研究组的麻醉起效时间短于对照组,麻醉维持时间明显长于对照组,差异有统计学意义(P<0.05);研究组术中补液量少于对照组,术后恢复饮食时间短于对照组,差异有统计学意义(P<0.05);研究组在T1、T2、T3时段的平均动脉压均高于对照组,差异有统计学意义(P<0.05);研究组的不良反应总发生率为5%,明显低于对照组的20%,差异有统计学意义(P<0.05)。结论超声引导下穿刺定位行腰丛-坐骨神经阻滞麻醉与硬膜外麻醉相比,具有麻醉起效快、维持时间长、对血流动力学影响小、不良反应发生率低等优点,对于高龄人工膝关节置换术患者值得推广运用。

Objective To explore the application effect of ultrasound-guided puncture lumbar plexus-sciatic nerve block in artificial knee joints for the elderly.Methods A total of80elderly patients undergoing artificial knee replacement from April2015to February2017treatd in our hospital were selected as the subjects,and randomly divided into research group and control group,with40cases in each group.The research group was given the lumbar plexus-sciatic nerve block under ultrasound-guidance.The control group was treated with epidural anesthesia.The anesthetic onset and maintenance time,blood loss,fluid volume,drainage volume,postoperative recovery time for dieting,HR,MAP,and adverse reactions were compared.Restults The anesthetic onset time of research group was significantly shorter than that of control group,the maintenance time of research group was significantly longer than that of control group,and the differences were statistically significant(P<0.05).The fluid volume of research group was less than that of control group,and postoperative recovery time for dieting was significantly shorter than that of control group,and the difference was statistically significant(P<0.05).The MAP of research group at T1,T2,T3were significantly higher than those of control group,and the differences were statistically significant(P<0.05).The total incidence of adverse reactions of research group was5%,which was significantly lower than that of control group(20%),and the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided Lumbar plexus-sciatic nerve block has rapid onset of anesthesia,long duration of maintenance,little influence on hemodynamics,and lower adverse reactions,which is worthy of clinical application.