超声引导下腰丛神经阻滞与骶管阻滞复合全麻在小儿髋关节手术中的比较  

Ultrasound guided lumbar plexus block combined with general anesthesia for pediatric hip surgery-A comparative study with caudal block combined with general anesthesia

作　　者：张晖[1] 张宇[1] 杨永刚[1] 严海[1] 王爱忠[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,200233

出　　处：《临床麻醉学杂志》2014年第8期755-757,共3页Journal of Clinical Anesthesiology

摘　　要：目的 比较超声引导下腰丛神经阻滞与传统骶管阻滞复合全麻在小儿髋关节手术中的临床应用效果.方法 择期行先天性髋关节手术患儿40例,年龄1～6岁,随机分为两组,分别采用超声引导下腰丛神经阻滞（L组）或骶管阻滞（C组）.两组均使用0.2％罗哌卡因1 ml/kg.记录术中芬太尼的用量,术后CHEOPS疼痛评分,以及术后首次使用PCA的时间和PCA总量.记录术中低血压、心动过缓的发生率,拔除导尿管的时间以及术后恶心呕吐的发生率.结果 L组首次使用PCA时间明显晚于C组,PCA总量明显低于C组,拔除导尿管的时间明显早于C组（P＜0.05）.两组在术中芬太尼的用量,术后CHEOPS疼痛评分,术中低血压、心动过缓的发生率,术后恶心呕吐的发生率差异无统计学意义.结论 超声引导下腰丛神经阻滞较骶管阻滞在小儿髋关节手术中镇痛时间更久,可安全有效地应用于临床.Objective To compare clinical effect especially about postoperative analgesic effect nbetween adjunctive ultrasound guided lumbar plexus block and caudal block for pediatric hip surgery under general anesthesia.Methods Forty ASA Ⅰ or Ⅱ children aged 1 to 6 years scheduled for hip surgery under general anesthesia were randomly assigned to 2 groups：adjunctive caudal block（group C,n=20） or adjunctive ultrasound guided lumbar plexus block （group L,n=20）.0.2％ ropivacaine 1 ml/kg was used in both blocks.Dose of intraoperative fentanyl,occurrence of hypotension and bradycardia were measured during the operation.After the operation,we recorded the time to first PCA,total dose of PCA,CHEOPS scores,the occurrence of PONV and the time of removing urine tube.Results The time to first PCA was earlier and the total dose of PCA was higher in group C than that in group L（P＜0.05）.The time of removing urine tube was earlier in group L than that in group C （P＜0.05）.There were no differences between the 2 groups regarding dose of intraoperative fentanyl,CHEOPS scores,occurrence of hypotension and bradycardia during the operation and PONV.Conclusion As an adjunction for general anesthesia,ultrasound guided lumbar plexus block provides safe and better postoperative analgesic effects compared with caudal block.

关 键 词：腰丛神经阻滞 超声引导 儿童 

分 类 号：R726.1[医药卫生—儿科]