超声和神经刺激仪引导下腰-骶丛神经阻滞在老年下肢动脉硬化闭塞症患者下肢高位截肢术中的应用

Application of Lumbosacral Plexus Nerve Block Guided by Ultrasound and Nerve Stimulator in High Amputation of Lower Limb in Elderly Patients with Lower Limb Arteriosclerosis Obliterans

目的:探讨超声和神经刺激仪引导下腰-骶丛神经阻滞在老年下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)患者下肢高位截肢术中的应用。方法:选择2017年1月-2021年1月笔者所在医院收治的择期行下肢高位截肢术的老年下肢ASO患者60例。按照入院时间先后顺序将其分为Ⅰ、Ⅱ组,每组30例。Ⅰ组给予超声和神经刺激仪引导下腰-骶丛神经阻滞,Ⅱ组给予腰-硬联合麻醉。比较两组不同时间点MAP、HR及不良反应发生情况。结果:两组不同时间点HR比较差异均无统计学意义(P>0.05)。Ⅱ组T_(2)、T_(3)时MAP均低于Ⅰ组,差异有统计学意义(P<0.05)。Ⅰ组术后不良反应发生率低于Ⅱ组,差异有统计学意义(P<0.05)。结论:超声和神经刺激仪引导下腰-骶丛神经阻滞麻醉对循环动力学的干扰小,能够维持老年下肢ASO患者下肢高位截肢手术过程中循环系统功能稳定,不良反应少。

Objective:To explore the application of lumbosacral plexus nerve block guided by ultrasound and nerve stimulator in high amputation of lower limb in elderly patients with lower limb arteriosclerosis obliterans(ASO).Method:A total of 60 elderly patients with lower limb ASO who underwent elective lower limb high amputation in our hospital from January 2017 to January 2021 were selected.According to the order of admission time,they were divided into groupⅠand groupⅡ,30 cases in each group.GroupⅠwas given ultrasound and nerve stimulator guided lumbosacral plexus nerve block,groupⅡwas given combined lumbar epidural anesthesia.MAP,HR at different time points and the incidence of adverse reactions were compared between the two groups.Result:There was no significant difference in HR between the two groups at different time points(P>0.05).MAP at T_(2) and T_(3) in groupⅡwere significantly lower than those in groupⅠ,the differences were statistically significant(P<0.05).The the incidence of adverse reactions in groupⅠwas lower than that in groupⅡ,the difference was statistically significant(P<0.05).Conclusion:Lumbosacral plexus nerve block anesthesia guided by ultrasound and nerve stimulator has little interference on circulatory dynamics in high amputation of lower limb in elderly patients with lower limb ASO,can maintain the stability of circulatory system function during surgery,with less adverse reactions.