腰丛-坐骨神经联合阻滞用于单侧大隐静脉曲张手术的临床效果  

Clinical Efficacy of Lumbar Plexus-sciatic Nerve Block in Patients Undergoing Unilateral Great Saphenous Varicose Veins Surgery

作　　者：李炯希 吴志云[1] 许培阳[1] 

机构地区：[1]中国人民解放军第180医院麻醉科,福建泉州362000

出　　处：《南昌大学学报（医学版）》2014年第12期70-73,91,共5页Journal of Nanchang University：Medical Sciences

摘　　要：目的观察腰丛-坐骨神经联合阻滞用于单侧大隐静脉曲张手术的临床效果。方法择期行大隐静脉曲张手术的患者80例,ASA分级Ⅰ—Ⅱ级,采用随机数字表法,将患者分为腰丛-坐骨神经联合阻滞组（N组,40例）和腰硬联合麻醉组（SE组,40例）。N组在神经刺激器引导下行腰丛-坐骨神经联合阻滞,腰丛阻滞时先注射1%利多卡因10～15 mL,再注射0.5%罗哌卡因10～15 mL,坐骨神经阻滞时先注射1%利多卡因15～20 mL,再注射0.5%罗哌卡因15～20 mL;SE组蛛网膜下腔注入0.75%罗哌卡因1.5～2.0 mL。分别于麻醉前（T0）、手术开始时（T1）、手术开始30 min时（T2）和手术结束时（T3）记录患者心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（Sp O2）,并记录2组患者感觉神经阻滞起效时间、持续时间、麻醉效果、麻黄素使用情况及术后不良事件（恶心、呕吐、低血压、头痛及尿潴留）发生情况。结果与SE组比较,N组患者T1—T2时MAP升高,感觉神经阻滞起效时间和持续时间延长,麻黄素使用率减少,术后恶心、头痛及尿潴留发生率降低（P〈0.05）,HR、Sp O2、麻醉效果、术后呕吐及低血压发生率比较差异无统计学意义（P〉0.05）。结论腰丛-坐骨神经联合阻滞用于单侧大隐静脉曲张手术可达到与腰硬联合麻醉相同的麻醉效果,且血流动力学更平稳,不良反应更少。Objective To investigate the clinical efficacy of lumbar plexus-sciatic nerve block in patients undergoing unilateral great saphenous varicose veins surgery. Methods Eighty ASA Ⅰ-Ⅱ patients aged 42-74 yr weighing 42-74 kg undergoing unilateral great saphenous varicose veins surgery were randomly divided into two groups（ n = 40） ： lumbar plexus-sciatic nerve block group（ group N） and combined spinal-epidural anesthesia group（ group SE）. The combined lumbar plexus-sciatic nerve block was performed in group N under the guidance of a nerve stimulator. 1% lidocaine and 0. 5% ropivacaine were used. For lumbar plexus block 1% lidocaine 10-15 m L was injected followed by 0. 5% ropivacaine 10-15 m L; whereas for sciatic nerve block 1% lidocaine 15-20 m L was injected followed by 0. 5% ropivacaine15-20 m L. In group SE,the combined spinal-epidural anesthesia was performed,and subarachnoid was injected with 0. 75% ropivacaine 1. 5-2. 0 m L. The heart rate（ HR）,mean arterial pressure（ MAP） and pulse oxygen saturation（ Sp O2） were recorded after admission to the operating room,at 0 and 30 min after the beginning of surgery,and at the end of surgery（ T0-T3）. The onset time and duration of sensory block,anesthesia efficacy,use of ephedrine after anesthesia was recorded,and The postoperative adverse reactions（ nausea,vomiting,hypotension,headache and urinary retention） were also observed and recorded.Results Compared with group SE,MAP was significantly increased at T1-T2,the onset time and duration of sensory block were significant prolonged,the use of ephedrine after anesthesia was decreased,and the incidence of postoperative nausea,headache and urinary retention were significant decreased in group N（ P〈0. 05）,while there was no significant difference in HR,Sp O2,anesthesia efficacy and the incidence of postoperative vomiting and hypotension（ P〈0. 05）. Conclusion The clinical efficacy of lumbar plexus-sciatic nerve block in patients undergoing unilateral great saphenous varicose

关 键 词：腰丛神经阻滞 坐骨神经阻滞 腰硬联合麻醉 大隐静脉曲张手术 

分 类 号：R614.4[医药卫生—麻醉学]