C型臂引导下腰丛联合坐骨神经阻滞用于老年患者下肢手术的临床观察  

Clinical application of C-arm guided lumbar plexus and sciatic nerve blockade on elderly patients with lower limb surgery

作　　者：田文华[1] 高嵩[1] 杨帆[1] 魏常 汤世玉 罗锋[1] 王磊[1] 叶张玲 

机构地区：[1]武汉市汉口医院麻醉科,湖北430012

出　　处：《中国临床新医学》2015年第12期1153-1156,共4页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

摘　　要：目的比较老年患者单侧下肢手术中c型臂引导下行腰丛联合坐骨神经阻滞与硬膜外麻醉的效果。方法选择60例ASAI～Ⅲ级拟行单侧下肢手术患者，根据随机余数法分为腰丛联合坐骨神经阻滞组（A组，n=30）和硬膜外麻醉组（B组，n=30），A组在C臂引导下行腰丛联合坐骨神经阻滞，两点分别给予0．375％罗哌卡因30ml（腰丛）、20ml（坐骨神经）；B组行硬膜外麻醉，给予0．375％罗哌卡因10-15ml。观察两组不同时点血流动力学变化、阻滞效果及其不良反应。结果A组在手术过程中的收缩压、舒张压、心率较B组平稳；A组用麻黄碱的患者显著少于B组（P〈0．01）；A组患者感觉神经阻滞起效时间长于B组（P〈0．01），但A组感觉神经及运动神经阻滞维持时间均明显长于B组（P〈0．01）；B组围术期出现恶心、呕吐、尿潴留不良反应明显高于A组（P〈0．01）。结论腰丛联合坐骨神经阻滞用于老年患者单侧下肢手术，不仅可满足手术需要，而且对老年患者血流动力学影响小，并发症少，镇痛维持时间长，不良反应少。尤其适合年老体弱患者的手术。Objective To compare the effects of C-arm guided lumbar plexus and sciatic nerve blockade and epidural anesthesia on elderly patients with lower limb surgery. Methods Sixty elderly cases （ ASA Ⅰ-Ⅲ ） were di- vided into the lumbar plexus and sciatic nerve blockade group （ group A, n = 30） and the epidural anesthesia group （ group B, n = 30）. Patients in group A received C-arm guided lumbar plexus and sciatic nerve blockade, with 30 ml and 20 ml of 0. 375% ropivaeaine administrated to the lumbar plexus and sciatic nerve respectively; Patients in group B received epidural anesthesia and were administrated with 10 - 15 ml of 0. 375% ropivacaine. Hemodynamie chan- ges, the effects of blockade and adverse reactions were observed in both groups. Results The systolic pressure, dias-tolic pressure and heart rate in group A were more stable than those in group B. The number of patients using ephed- rine in group A was much smaller than that in group B（P 〈0.01 ）. The sensory block onset time of group A was lon- ger than that of group B（P 〈0.01）, while the hold time of sensory and motor nerve block onset time of group A was significantly longer than that of group B（P 〈0.01 ）. Adverse reactions such as nausea, vomit and retention of urine in group B during the preoperative period were much more severe than those in group A（ P 〈 0.01 ）. Conclusion The application of lumbar plexus and sciatic nerve blockade in unilateral lower limb surgery can not only meet the sur- gical requirements, but also have a small impact on hemodynamics, less complications, longer duration of pain relief and less adverse reactions. Therefore, it is especially suitable for frail elderly patients.

关 键 词：神经传导阻滞 C型臂引导下 老年人 麻醉 下肢手术 

分 类 号：R614.4[医药卫生—麻醉学]