26例腰丛-骶丛阻滞联合腰方肌阻滞在全髋关节置换术中的应用

Application of 26 Cases of Lumbar Plexus-pupillary Plexus Block Combined with Lumbar Muscle Block in Total Hip Arthroplasty

目的探讨腰丛-骶丛阻滞联合腰方肌阻滞在全髋关节置换术的应用效果。方法选取开远市人民医院2018年10月至2019年2月收治的26例择期行单侧全髋关节置换术患者,所有患者均在全髋关节置换术中接受腰丛-骶丛阻滞联合腰方肌阻滞。观察26例患者的图像分级、麻醉起效时间,采用自制量表评估患者对麻醉程度的满意度,记录术中不良反应。结果22例患者超声图像分级为优,4例患者因“三叶草”影像不清,改为“三叉戟”腰丛阻滞。起效时间平均(24.5±4.7)min。术者对麻醉满意程度均为10分。所有患者术中均未出现局麻药中毒反应、呼吸抑制、血压大幅度波动。结论腰骶丛神经阻滞联合腰方肌阻滞可以满足全髋关节置换手术需求,且腰方肌和腰丛阻滞为一针二点,在超声引导下进行,定位更准确,创伤更小,缩短麻醉操作时间,提高术者满意度。

Objective To investigate the effect of lumbar plexus-pupillary plexus block combined with lumbar muscle block in total hip arthroplasty.Methods Twenty-six patients undergoing elective unilateral total hip arthroplasty from October 2018 to February 2019 in Kaiyuan People's Hospital were selected.All patients underwent lumbar plexus-temporal block combined with total hip arthroplasty.Lumbar muscle block.The image classification and the onset time of anesthesia were observed in 26 patients.The self-made scale was used to evaluate the patient's satisfaction with the degree of anesthesia,and the adverse reactions during the operation were recorded.Results The ultrasound images of 22 patients were excellent.Four patients were changed to"trident"lumbar plexus block because of the unclear image of"three-leaf clover".The onset time was average(24.5±4.7)min.The surgeon was satisfied with anesthesia by 10 points.All patients had no local anesthetic poisoning reaction,respiratory depression,and large fluctuations in blood pressure during surgery.Conclusion Lumbar plexus block combined with lumbar muscle block can meet the needs of total hip arthroplasty,and the lumbar muscle and lumbar plexus block are two points.Under ultrasound guidance,the positioning is more accurate and the trauma is smaller.Shorten the operation time of anesthesia and improve the satisfaction of the surgeon.