两种麻醉方法用于老年糖尿病患者胫骨横向骨搬移术的比较

Comparison of two methods of anesthesia for transverse tibial bone transposition in elderly patients with diabetes

目的比较两种麻醉方法在老年糖尿病患者胫骨横向骨搬移术中的效果。方法选择拟行单侧胫骨横向骨搬移术患者60例,男30例,女30例,年龄65～89岁,ASA II级,BMI 18～24 kg/m^2。随机分为腘窝处坐骨神经联合股神经阻滞组(NB组)和硬膜外麻醉组(EA组)。NB组在超声引导下正确定位坐骨神经和股神经后分别给予0.375%罗哌卡因各15～20 ml。EA组取L_(2～3)穿刺点行硬膜外麻醉,2%利多卡因3 ml试验剂量后,分次给予0.75%罗哌卡因10～15 ml。记录两组患者术中输液量、使用麻黄碱情况。记录两组患者阻滞前、阻滞后10、20、30、60 min和术后60 min的HR和MAP。记录两组患者感觉和运动神经阻滞起效时间、完善时间、持续时间。记录有无穿刺部位出血、局麻药不良反应、新发神经系统病变,记录尿潴留、恶心呕吐等不良反应发生情况。结果 NB组术中输液量、术中使用麻黄碱例数明显少于EA组(P<0.05)。与阻滞前比较,阻滞后10、20、30、60 min和术后60 min EA组MAP明显降低(P<0.05),阻滞后10、20、30、60 min和术后60 min NB组MAP明显高于EA组(P<0.05),两组HR差异无统计学意义。两组患者感觉、运动神经阻滞起效时间和完善时间差异无统计学意义。NB组感觉神经阻滞持续时间明显长于EA组(P<0.05),运动神经阻滞持续时间明显短于EA组(P<0.05)。两组患者均无一例出现穿刺部位出血、局麻药中毒及新发神经系统病变。NB组尿潴留和恶心呕吐发生率明显低于EA组(P<0.01)。结论与硬膜外麻醉相比较,坐骨神经联合股神经阻滞应用于老年糖尿病患者胫骨横向骨搬移术,对血流动力学影响小,阻滞效果好、术后镇痛时间长,不增加并发症发生。

Objective To comparatively evaluate two methods of anesthesia during transverse tibial bone transport in elderly diabetic patients.Methods Sixty patients of ASA physical status II scheduled for lateral tibial bone removal surgeries were enrolled,including 30 males and 30 females,aged 65-89 years and BMI 18-24 kg/m2.The patients were randomly divided into two groups:the combined popliteal sciatic and femoral nerve block(group NB)and epidural anesthesia group(group EA).Group NB was received 15-20 ml of 0.375%ropivacaine for popliteal sciatic nerve and femoral nerve block respectively after correctly locating using ultrasound.group EA received epidural anesthesia and punctures were performed at L2-3,2%lidocaine 3 ml test dose was given,then 0.75%ropivacaine 10-15 ml was given by several times.Intraoperative infusion volume and ephedrine usage were recorded.MAP and heart rate(HR)were recorded before and 10,20,30,60 minutes after block and 60 minutes after operation.Onset time,time required for complete block and duration of sensory and motor block were recorded for the two groups.Hematoma at puncture site,local anesthetic intoxication,other complications of the nervous system,urinary retention,nausea,vomiting and other adverse events were compared between the two groups.Results Compared with group EA,intraoperative infusion volume was significantly reduced in group NB(P<0.05).Also,the number of cases using ephedrine during operation was significantly lower in group NB than that in group EA(P<0.05).MAP was significantly decreased at 10,20,30,60 minutes after anesthesia and 60 minutes after block compared with that before induction of anesthesia in group EA.MAP was significantly higher in group NB than that in group EA at 10,20,30,60 minutes after block and 60 minutes after operation(P<0.05),while no statistical significance differences was noted of HR between the two groups.No difference of onset time,time required for complete sensory and motor block between two groups.The duration of sensory block in group NB was significantly longer than that in group EA(P<0.05),while the duration of motor block was significantly shorter(P<0.05).No hematoma at puncture site,local anesthetic intoxication or other complications of the nervous system were observed in the two groups.However,the rate of urinary retention as well as nausea and vomiting were significantly lower in the group NB than those in group EA(P<0.01).Conclusion Compared with epidural anesthesia,combined popliteal sciatic and femoral nerve block for elderly diabetic patients undergoing transverse tibial bone transport showed less effects on hemodynamics,better quality of blockade,prolonged time of analgesic effects and no complications found.