神经刺激仪引导的腰丛及坐骨神经阻滞在38例老年下肢手术的应用

Application of nerve stimulator-guided lumbar plexus and sciatic nerve block in 38 cases of elderly lower limb surgery

目的探讨神经刺激仪引导的腰丛及坐骨神经阻滞在老年下肢手术中的应用效果。方法选择阳江市阳东区人民医院麻醉科2019年1月—2021年11月开展下肢手术的老年患者76例,采用随机数字表法分为常规组与观察组(38例/组),常规组采用连续硬膜外麻醉,观察组采用神经刺激仪引导的腰丛及坐骨神经阻滞。观察两组麻醉前(T0)、麻醉后30 min(T1)、麻醉后60 min(T2)、术后1 h(T3)患者血流动力学(收缩压(SBP)、舒张压(DBP)、心率(HR)),比较两组麻醉情况、麻醉效果及不良反应发生情况。结果常规组与观察组在T0、T1、T2、T3时SBP、DBP、HR水平差异无统计学意义(P>0.05);常规组与观察组感觉、运动阻滞起效时间比较,差异无统计学意义(P>0.05),观察组感觉、运动维持时间长于常规组,差异有统计学意义(P<0.05);观察组麻醉效果优于常规组,不良反应发生率低于常规组,差异有统计学意义(P<0.05)。结论神经刺激仪引导的腰丛及坐骨神经阻滞在老年下肢手术中应用,可稳定患者血流动力学,增强感觉、运动阻滞维持时间,麻醉效果好,安全性高。

Objective To investigate the effect of lumbar plexus and sciatic nerve block guided by nerve stimulator in elderly lower limb surgery.Methods A total of 76 elderly patients with lower limb surgery were selected from the Department of Anesthesiology of Yangdong District People’s Hospital,Yangjiang City from January 2019 to November 2021.They were divided into a routine group and an observation group(38 cases in each group)by random number table method;the routine group adopted continuous epidural anesthesia,and the observation group adopted a nerve stimulator-guided lumbar plexus and sciatic nerve block.The hemodynamics[systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)]before anesthesia(T0),30 min after anesthesia(T1),60 min after anesthesia(T2),and 1 h after surgery(T3)],anesthesia conditions,anesthesia effect,and adverse reactions were compared between two groups.Results There were no significant differences in SBP,DBP,and HR between the routine group and the observation group at T0,T1,T2,and T3(P>0.05);there were no significant differences in the onset time of sensory and motor block between the two groups(P>0.05),and the observation group maintained longer sensation and movement than the routine group(P<0.05);the observation group showed a better anesthesia effect and a lower incidence rate of adverse reactions than the routine group(P<0.05).Conclusion Lumbar plexus and sciatic nerve block guided by nerve stimulator for elderly lower extremity surgery can stablize patient's hemodynamics,enhance the maintainance of sensory and motor block,and has a good anesthesia effect with high safety.