超声引导下腰丛-坐骨神经阻滞在老年膝关节镜手术中的效果分析

The anesthesia effects of ultrasound-guided lumbar plexus-sciatic nerve block in elderly patients undergoing knee arthroscopic surgery

目的探究超声引导下腰丛-坐骨神经阻滞在老年膝关节镜手术中的应用情况和麻醉效果。方法选取2018年1月至2019年12月收治的行单侧膝关节镜手术的老年患者90例。将所有患者随机分为对照组和研究组,每组45例。对照组患者采用硬膜外麻醉,研究组患者采用超声引导下腰丛-坐骨神经阻滞。比较2组患者麻醉优良率、感觉运动阻滞情况、麻醉前后血流动力学其情况以及不良反应发生情况。结果研究组患者麻醉优良率为97.78%,高于对照组患者的82.22%(P<0.05)。研究组患者感觉阻滞起效时间、最高平面出现和运动阻滞起效时间短于对照组,而最高平面维持时间和运动阻滞维持时间长于对照组(P<0.05)。麻醉前,2组患者心率、收缩压、舒张压的差异均无统计学意义(P>0.05);麻醉15 min和30 min时,2组患者心率差异均无统计学意义(P>0.05),研究组收缩压、舒张压均高于对照组(P>0.05)。研究组患者不良反应总发生率为4.44%,低于对照组患者的22.22%(P<0.05)。结论超声引导下腰丛-坐骨神经阻滞能够提高老年患者在膝关节镜手术中的麻醉效果,达到理想的神经阻滞效果,有利于患者术中血压的问题,减少了不良反应的发生,保障了麻醉和手术治疗的安全性。

Objective To investigate the anesthesia effects of ultrasound-guided lumbar plexus-sciatic nerve block in elderly patients undergoing knee knee arthroscopic surgery.Methods Ninety elderly patients who underwent unilateral knee knee arthroscopic surgery in our hospital from January 2018 to December 2019 were enrolled in the study,who were randomly divided into control group(n=45)and research group(n=45).The patients in control group received epidural anesthesia,however,and patients in research group received ultrasound-guided lumbar plexus-sciatic nerve block.The good/excellent rate of anesthesia,sensorimotor block,hemodynamics before and after anesthesia,and the occurrence of adverse reactions were observed and compared between the two groups.Results The good/excellent rate of anesthesia in research group was 97.78%,which was significantly higher than that(82.22%)in control group(P<0.05).The onset time of sensory block,the appearance time of the highest plane and the onset time of motor block in the research group were significantly shorter than those in control group,while the maintenance time of the highest plane and the maintenance time of motor block were significantly longer than those in control group(P<0.05).Before anesthesia,there were no significant differences in heart rate(HR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)between the two groups(P>0.05),and at 15 min and 30 min after anesthesia,there was no significant difference in HR between the two groups(P>0.05),but the SBP and DBP of the research group were significantly higher than those in control group(P>0.05).The total incidence of adverse reactions in research group was 4.44%,which was significantly lower than that(22.22%)in control group(P<0.05).Conclusion Ultrasound-guided lumbar plexus-sciatic nerve block can improve the anesthesia effect of knee arthroscopy in the elderly patients,achieve the ideal nerve block effect,be helpful for patients with intraoperative blood pressure problems,reduce the occurrence of adverse reactions,and ensure the safety of anesthesia and surgical treatment.