超声引导下神经阻滞在基层医院的推广应用

Popularization and application of ultrasound-guided nerve block in primary hospitals

目的探讨超声引导下神经阻滞在基层医院的推广应用效果。方法2018年6月至2019年12月采用理论知识培训和上门指导相结合的形式将超声引导下神经阻滞推广应用至丽水市6家县级医院。同时抽取6家县级医院股骨颈骨折患者80例,采用随机数字表法随机分为试验组及对照组,试验组在超声引导下定位腰丛及坐骨神经,分别推注0.33%盐酸罗哌卡因+0.5%利多卡因30 mL;对照组实行腰硬联合麻醉,蛛网膜下腔注射2 mL 0.5%的盐酸罗哌卡因。比较两组的麻醉起效与维持时间,麻醉效果及生命体征变化情况。结果麻醉医师在培训后超声引导下神经阻滞的知识掌握合格率明显提高(P<0.05)。与对照组比较,试验组起效及维持时间均延长(P<0.05);麻醉后血流动力学更平稳(P<0.05);两组的麻醉效果比较,差异无统计学意义(P>0.05)。结论在基层医院推广超声引导下神经阻滞适宜技术大大提高基层麻醉医师临床技术水平,降低老年骨折患者围术期麻醉风险,使更多患者在基层医院得到安全诊治。

Objective To explore the popularization and application effect of ultrasound-guided nerve block in primary hospitals.Methods A combination of theoretical knowledge training and on-site guidance was used to promote and apply ultrasound-guided nerve block to 6 county-level hospitals in Lishui City from June 2018 to December 2019.At the same time,80 patients with femoral neck fractures from 6 county-level hospitals were selected and randomLy divided into the experimental group and the control group by random number table method.The experimental group was guided by ultrasound to locate the lumbar plexus and sciatic nerve and injected with 0.33% ropivacaine hydrochloride+0.5% lidocaine 30 mL.The control group was treated with combined spinal-epidural anesthesia,and 2 mL 0.5% ropivacaine hydrochloride was injected into the subarachnoid cavity.The onset and maintenance time of anesthesia,anesthesia effect,and vital signs changes of the two groups were compared.Results The pass rate of anesthesiologists'knowledge of nerve block under ultrasound guidance increased significantly after training(P<0.05).Compared with control group,the nset and maintenance time of the experimental group were prolonged(P<0.05),and hemodynamics of lumbar plexus-sciatic nerve block after anesthesia were more stable(P<0.05).There was no statistical difference in the anesthesia effect between the two groups.Conclusion The promotion of ultrasound-guided nerve block suitable technology in primary hospitals has greatly improved the clinical skills of primary anesthesiologists,reduced the risk of perioperative anesthesia for elderly fracture patients,and enabled more patients to receive safe diagnosis and treatment in primary hospitals.