神经刺激仪联合超声引导行外周神经阻滞麻醉在老年患者四肢创面修复手术中的应用

Application of peripheral nerve block by nerve stimulator combined with ultrasound in the elderly patients with limb wound repair surgery

目的探讨神经刺激仪联合超声引导行外周神经阻滞麻醉在老年四肢创面修复手术中的疗效。方法回顾性分析2014年7月—2018年12月上海交通大学医学院附属新华医院(崇明)收治的80例行四肢创面修复手术肢体创伤老年患者,男性52例,女性28例;年龄65~93岁,平均73.5岁;锐性伤62例,钝性伤18例。采用单独神经刺激仪或联合超声行外周神经阻滞麻醉,随机数字表法分成四组,每组20例:第一组为上肢手术单独应用神经刺激仪(US组);第二组为上肢手术神经刺激仪联合超声应用(UU组);第三组为下肢手术单独应用神经刺激仪(LS组);第四组为下肢手术神经刺激仪联合超声应用(LU组)。运用t检验和χ2检验分析不同组别阻滞完成时间和起效时间、镇痛持续时间、麻醉效果、心率和血压等指标的差异。结果UU组和LU组的阻滞完成时间(3.1±0.9)min、(10.5±2.6)min和阻滞起效时间(14.2±3.1)min、(11.1±3.6)min短于US组和LS组(4.2±0.8)min、(20.5±6.3)min、(19.6±2.3)min、(14.5±4.2)min,差异有统计学意义(P<0.05)。镇痛持续时间、麻醉效果、心率和血压比较差异无统计学意义(P>0.05)。结论神经刺激仪联合超声行神经阻滞麻醉,阻滞完成时间更短、见效更快,建议推广。

Objective To explore the efficacy of peripheral nerve block by nerve stimulator combined with ultrasound on the repair of limb wounds in elderly patients.Methods From Jul.2014 to Dec.2018,a retrospective study was performed on 80 elderly patients(52 males and 28 females)with limb wound repair surgery in Xinhua Hospital(Chongming)of Shanghai Jiaotong University.The age of the selected patients ranged from 65 to 93 years(average age 73.5 years).There were 62 cases of blunt injury and 18 cases of sharp injury.Peripheral nerve block were performed by nerve stimulator combined with ultrasound or by nerve stimulator.Patients were randomly divided into four groups(20 cases per group).Group US:only nerve stimulator in upper limb surgery;Group UU:nerve stimulator along with ultrasound in upper limb surgery;Gruop LS:only nerve stimulator in lower limb surgery;Group LU:nerve stimulator along with ultrasound in lower limb surgery.T-test and chi-square test were applied to analyze the differences on block completion time,block effective time,duration of analgesia,anesthetic effect,heart rate and blood pressure among the four groups.Results The block completion time of group UU(3.1±0.9)was significantly shorter than that of group US(4.2±0.8).The block completion time of group LU(10.5±2.6)was significantly shorter than that of group LS(20.5±6.3).The block onset time of group UU(14.2±3.1)was significantly shorter than that of group US(19.6±2.3).The block onset time of group LU(11.1±3.6)was significantly shorter than that of group LS(14.5±4.2).There was no statistical significance in other indexes among four groups.Conclusion Due to shorter block completion time and block onset time,nerve stimulator combined with ultrasound can be recommended in nerve block anesthesia.