超声引导下腰丛阻滞在90岁以上高龄患者PFNA术中的应用  

Effects of ultrasound guided lumbar plexus nerve block in elderly patients over 90year-old under Proximal Femoral Nail Antirotation

作　　者：赵若光[1] 龚灿生[1] 林莹[1] 邹聪华[1] 陈彦青[1] 

机构地区：[1]福建省立医院麻醉科,福州350001

出　　处：《福建医药杂志》2013年第4期100-102,共3页Fujian Medical Journal

基　　金：福建省卫生厅面向农村和城市社区推广适宜技术项目(2012005)

摘　　要：目的观察超声引导下腰丛神经阻滞在90岁以上高龄患者股骨近端髓内钉(PFNA)术中的应用效果。方法2011年1月至12月我院收治的6例90岁以上单侧股骨粗隆间骨折行PFNA手术患者,在超声引导下用0.375%罗哌卡因与1%利多卡因混合液行单侧腰丛神经阻滞。观察患者入室后10min、阻滞后5、10、15、20、25、30min时的收缩压(SBP)、舒张压(DBP)、心率(HR);记录患者局麻药使用量,感觉和运动阻滞起效及持续时间,神经阻滞并发症及恶心、呕吐、尿潴留的发生情况。结果患者各时间点血压及心率差异无统计学意义(P>0.05)。感觉及运动神经阻滞起效时间分别为(7.2±2.16)min和(11.3±3.24)min,持续时间分别为(10.6±3.2)h和(7.4±2.6)h,感觉神经阻滞起效时间快于运动神经,且维持时间更长(P<0.05)。6例患者用药量为20～25mL。除一例患者术中诉有轻度疼痛,予加用少量咪达唑仑及舒芬太尼后安静入睡外,余患者均获得满意的效果。所有患者均未发生局麻药中毒、周围器官损伤、局部血肿或神经损伤、恶心、呕吐、尿潴留等情况。结论超声引导下腰丛神经阻滞,效果确切,并发症少,安全可靠,尤其适用于拟行PFNA术的高龄患者。Objective To observe the effect of ultrasound guided lumbar plexus nerve block in elderly patients over 90 year-old under Proximal Femoral Nail Antirotation （PFNA）. Methods Six elderly patients over 90 year-old admitted to our hospital with intertrochanteric fracture undergoing PFNA in 2011 were picked out into this observation. They received ultra- sound guided lumbar plexus nerve block with mixture of 0. 375% ropivaeaine and 1 % lidocaine for PFNA. The observed indexes included systolic BP （SBP）, diastolic BP （DBP） and HR when entering the operating room, 5, 10, 15, 20, 25 and 30 rain af- ter nerve block were executed, the usage of local anesthetics, the onset time and duration of sensory and motor block, the com- plications of nerve block, nausea, vomit and uroschesis. Results There were no significant differences in SBP, DBP and HR of each time points （P〉0. 05）. The onset time of sensory and motor block were （7.2±2.16） min and （11.3±3.24） min sepa- rately, when the duration of each were （10.6±3.2） h and （7.4±2.6） h. The onset time of sensory block was quick than that of motor when the duration of sensory block was longer than that of motor （P〈0.05）. The volumes of anesthetics varied from 20 to 25 mL. All cases obtained satisfactory results except one with slight pain relieved by small doses of midazole and sufen- tanil. No complication was founded. Conclusion Ultrasound guided lumbar plexus nerve block has definite effect and less corn plications, especially suitable for elderly patients undergoing PFNA.

关 键 词：超声引导下腰丛神经阻滞 高龄 股骨近端髓内钉 

分 类 号：R445.1[医药卫生—影像医学与核医学] R614.2[医药卫生—诊断学]