神经刺激器辅助下腰丛联合坐骨神经阻滞在老年患者下肢手术中的应用  

Clinical study of lumbar plexus/sciatic nerve block using peripheral nerve stimulator and epidural anesthesia in the lower extremity surgery in elderly patients

作　　者：章蔚[1] 疏树华[1] 方才[1] 邵春晓[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥230001

出　　处：《安徽医学》2011年第12期2006-2009,共4页Anhui Medical Journal

摘　　要：目的比较神经刺激器辅助下腰丛联合坐骨神经阻滞与硬膜外麻醉在老年患者下肢手术中的麻醉效果。方法 46例下肢手术的老年患者随机分为硬膜外麻醉组(E组,n=25)和腰丛联合坐骨神经阻滞组(N组,n=21)两组。E组行连续硬膜外麻醉,硬膜外腔向头侧置管,给予1%利多卡因+0.375%罗哌卡因10～14 ml;N组行神经刺激仪辅助下腰丛联合坐骨神经阻滞,局麻药为0.45%罗哌卡因,腰丛阻滞剂量25～30 ml,坐骨神经阻滞剂量20～25 ml。记录并比较两组麻醉血流动力学、起效维持时间、术后首次排尿时间、住院时间、麻醉效果、辅助用药、不良反应。结果两组患者血流动力学比较,E组麻醉后15、20、30 min MAP下降(P<0.05),E组麻醉后30 min MAP低于N组(P<0.05);E组运动完全阻滞时间(T2)、感觉恢复时间(T3)、运动恢复时间(T4)低于N组(P<0.05),术后首次排尿时间(Tu)长于N组(P<0.05);N组并发症少于E组。结论神经刺激器辅助下腰丛联合坐骨神经阻滞用于老年患者下肢手术,阻滞完善,麻醉效果确切,血流动力学平稳,并发症少,尤其适合年老、体弱且相对长时间患者。Objective The study sought to compare the efficacy of lumbar plexus/sciatic nerve block using peripheral nerve stimulator and epidural anesthesia in the lower extremity surgery in elderly patients. Methods forty-six patients undergoing the lower limb surgery were randomly divided into two groups： group E （epidural anesthesia group, n=25 ）; group N （lumbar plexus/sciatic nerve block group, n=21 ）. The patients in group E received epidural anestheisa and epidural catheter. The local anesthetic drug was the mixed solution 4ml of 1% lidoeaine and 0.375% ropivicaine. Furthermore, the mixed solution 6-10 would be given through epidural catheter if necessary. The patients in group N received lumbar plexus/sciatic nerve block using peripheral nerve stimulator. The local anesthetic drug was 0.45% ropivacaine, and the amount of drug for lumber plexus blockade was 25-30 ml and 20-25 ml for sciatic plexus blockade. The hemodynamies, onset time, duration, the first urine time of postoperation, length of stay, efficacy, auxiliary agents and adverse reactions of two groups were recorded. Results In hemodynamics, the mean artery pressure（MAP） of Tls（fifteen minutes after anesthesia）, T20（twenty minutes after anesthesia） and T3o（thirty minutes after anesthesia）in group E were decreased than that of To （baseline） （P〈0.05）; compared with group N, MAP of T30 in group E was lower （P〈 0.05）. T2（the onset time of motor block）, T3（analgesia） and T4（the duration of motor block） of group E were shorter than those of group N（P〈 0.05 ）. However, Tu（the first urine time of postoperation）of group E was longer（P〈0.05）. The complications of group N were less than group E. Conclusion The anesthetic strategy of lumbar plexus/sciatic nerve block using peripheral nerve stimulator will lead to complete blockade, pre-

关 键 词：老年患者 腰丛联合坐骨神经联合阻滞 硬膜外麻醉 外周神经刺激器 

分 类 号：R614[医药卫生—麻醉学]