改良持续腰丛神经阻滞麻醉在高龄腹股沟疝患者手术中的应用  

Application of improvement of continuous lumbar plexus block anesthesia in elderly inguinal hernia

作　　者：林大勇[1] 金刚[1] 马德祥[1] 

机构地区：[1]四川省医学科学院.四川省人民医院草堂病区麻醉科,四川成都610072

出　　处：《西部医学》2013年第4期525-527,共3页Medical Journal of West China

摘　　要：目的探讨对比改良持续腰丛神经阻滞麻醉与腰硬联合麻醉在高龄患者腹股沟疝手术中的麻醉效果及不良反应。方法选择拟行腹股沟疝高龄手术患者60例,按随机数字表法分为试验组和对照组各30例。试验组采用改良持续腰丛神经阻滞麻醉,对照组采用腰硬联合麻醉。观察并记录麻醉前(T0)、注药后5min(T1)、10min(T2)、20min(T3)、30min(T4)及术毕(T5)时间点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2);麻醉起效时间、完善时间、维持时间,评价麻醉效果,术中、术后发生恶心、呕吐,头痛,尿潴留等不良反应的例数。结果试验组HR、MAP、SPO2注药前后各时间点变化无统计学意义,对照组HR、MAP在注药后T1、T2与T0比较有统计学意义(P<0.05),SPO2注药前后各时间点变化无统计学意义;麻醉起效、完善时间对照组优于试验组,维持时间两组比较无统计学意义;两组优良率均100%,均顺利完成手术;对照组有3例恶心、呕吐,6例术后尿潴留。结论改良持续腰丛神经阻滞麻醉,具备了完善的麻醉镇痛效果,在利于维持术中血流动力学平稳,保证重要组织器官的血流灌注,在高龄患者腹股沟疝的手术中具有很高的应用价值。Objective To investigate the contrast improvement continuous lumbar plexus block anesthesia and combined spinal-epidural anesthesia in elderly patients with inguinal operation in the anesthesia effect and adverse reaction. Methods Selecting the intended line of inguinal hernia in elderly patients with operation in 60 cases, were randomly divided into experimental group and control group with 30 cases in each group. The test group using the modified continuous lumbar plexus nerve block anesthesia, the control group using combined spinal-epidural anesthesia. Observing and recording before anesthesia （ TO ）, 5rain after injection （ T1 ）, 10min （ T2 ）, 20min （ T3 ）, 30min （ T4 ） and the end of operation （ T5 ） at the time of heart rate （ HR ）, mean arterial pressure （ MAP ）, oxygen saturation （SPOz） ; anesthetic onset time, perfect time time, maintenance; evaluation of anesthetic effect, excellent （ intraoperative analgesia, do not give any analgesic drugs ）, good （ mild stretch of discomfort or pain, postoperative analgesia, only give a small amount of sedative drugs ）, difference （ pain, can not tolerate operation, need to a large number of analgesic drugs or change; intraoperative anesthesia ）, the incidence of postoperative nausea, vomiting, headache, urinary retention and other adverse reaction cases. Results The trial group, HR, MAP, SPOz injection at different time points before and after the change was not statistically significant, the control group HR, MAP at T1,T2 after injection, compared with TO statistical significance （ P〈0. 05 ）, SPOz injection time points before and after the change was not statistically signifi- cant; anesthetic onset time, improve the control group was better than the test set, hold time between the two groups was not statistically significant; two groups were excellent in all 100%, the operation was successful~ the control group had 3 cases of nausea, vomiting, 6 cases of postoperative urinary retention. Conclusion The modified

关 键 词：持续腰丛神经阻滞 高龄 腹股沟疝 

分 类 号：R656.21[医药卫生—外科学] R614.4[医药卫生—临床医学]