三点法神经阻滞麻醉在老年患者下肢手术中的应用  

The application of three-point nerve block anesthesia in old patients undergoing lower limb surgery

作　　者：陈璟莉[1] 严虹[1] 

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院麻醉科,湖北武汉430014

出　　处：《中国现代医学杂志》2011年第22期2808-2810,2813,共4页China Journal of Modern Medicine

摘　　要：目的比较神经刺激仪引导下的的腰丛-坐骨神经-股神经联合阻滞与硬膜外阻滞在老年患者下肢手术的临床效果。方法 110例ASAⅠ～Ⅲ级拟行下肢手术的老年患者,随机分为腰丛-坐骨神经-股神经联合阻滞组(A组,n=55)和硬膜外阻滞组(B组,n=55),记录两组患者麻醉前、手术开始时和手术结束时血压和心率的变化。观察两组患者感觉和运动阻滞的起效时间、持续时间及阻滞效果。结果手术开始时B组患者的血压明显降低,心率增快,并持续至手术结束以后(P<0.05),而A组患者均无明显变化(P>0.05)。A组患者感觉和运动阻滞的起效时间明显短于B组,感觉和运动阻滞的维持时间明显长于B组(P<0.05)。两组患者的麻醉效果无明显差异(P>0.05),术中均未出现止血带疼痛现象。结论神经刺激仪引导下的三点法神经阻滞麻醉具有血流动力学稳定、镇痛完善持久和并发症少等优点,适合用于老年患者的下肢手术。【Objective】 To compare the anesthetic effect between lumbar plexus-sciatic-femoral plexus nerve block guided by nerve stimulator and epidural block in old patients undergoing lower limb surgery.【Methods】 110 old patients,ASA physical status of Ⅰ～Ⅲ,undergoing lower limb surgery were allocated into two groups： lumbar plexus-sciatic-femoral plexus nerve block group（A group,n =55） and epidural block group（B group,n =55）.The change of blood pressure and the heart rate was recorded before two groups of patients are anaesthetized,when operations begin and over.Up-effect time and sustained time of feeling and motion block,block effect of two groups of patients were observed.【Results】 The blood pressure reduced obviously and heart rate increased quickly when operation begun in the B group,and it continued until operation was over（P 0.05）,but the change was not obvious in the A group（P 0.05）.The up-effect time of feeling and motion block was shorter obviously,the sustained time of feeling and motion block was longer in the A group than in the B group（P 0.05）.Anaesthesia effect of two groups of patients had no obvious difference（P 0.05）.The pain arousing from the tourniquet didn＇t appear during the operations.【Conclusion】 The three-point nerve block anesthesia guided by nerve stimulator with stabile blood flow mechanics,consummate anaesthesia effect and less complication is fit to the old patients undergoing lower limb surgery.

关 键 词：神经刺激仪 腰丛-坐骨神经-股神经联合阻滞 硬膜外阻滞 老年患者 下肢手术 

分 类 号：R614.3[医药卫生—麻醉学]