腰丛-坐骨神经阻滞与腰麻在老年患者膝关节置换围术期的对比分析  

Comparison of lumbar plexus-sciatic nerve block and spinal anesthesia on elderly patients with knee joint surgery during the perioperative period

作　　者：黄文锋[1] 陈杰[1] 包晓航[1] 杜智勇[1] 黄河[1] 李洪[1] 杨天德[1] 

机构地区：[1]第三军医大学新桥医院麻醉科,重庆400037

出　　处：《局解手术学杂志》2016年第9期636-640,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(81370210);重庆市自然科学基金(2009BB5150)

摘　　要：目的：对比分析腰丛联合坐骨神经阻滞与腰麻在老年患者膝关节手术中的应用，探讨两者在老年患者膝关节置换术围手术期的优缺点。方法77例老年单膝关节置换术患者，ASA Ⅰ～Ⅲ级，按麻醉方式不同分为腰丛神经阻滞联合坐骨神经阻滞组（联合组）和腰麻组，观察并纪录麻醉前基础值，以及麻醉后、切皮时、术中放置骨水泥后、手术结束时的血压、心率、阻滞区域及维持时间、术中输液量、围术期不良反应等指标。结果腰麻组患者在麻醉后 MAP、SBP、DBP 在 T1、T2、T3时间点波动明显，联合组麻醉操作所用时间、镇痛起效、维持时间上长于腰麻组，麻醉阻滞范围上联合组小于腰麻组，围术期不良反应发生情况上联合组明显低于腰麻组。结论腰麻阻滞完善，但极易对血流动力学造成影响，围术期不良反应较多；腰丛-坐骨神经阻滞安全、有效，围术期不良反应少，对血流动力学影响小，对临床上的高龄凝血功能异常并合并心肺疾患的患者更为有利。Objective To compare and analyze the clinical application of lumbar plexus combined with sciatic nerve block and spinal anesthesia for elderly patients with knee joint surgery.Methods A total of 77 elderly patients with ASAⅠ ~Ⅲ undergoing single knee re-placement surgery were randomly divided into combined group which recieved lumbar plexus combined with sciatic nerve block and spinal an-esthesia group.The baseline values,blood pressure and heart rate at multiple time points,the block area and duration,the volume of intraoper-ative fluid,and other indexes of adverse reaction were observed.Results The MAP,SBP and DBP in the spinal anesthesia group after the op-eration have changed significantly at the time of T1,T2 and T3.The operating of anesthesia in the combined group was shorter than that of spi-nal anesthesia group.The rate of adverse reactions in combined group was significantly lower than that inspinal anesthesia group.Conclusion The spinal anesthesia can be satisfied for operation requirements,but it will cause the unstable circulation and varied adverse reactions.Lum-bar plexus combined with sciatic nerve block is safe and effective with less adverse reactions,less disturbance of hemodynamics,which is much better for the old or the patients with coagulation abnormalities combined heart and lung disease.

关 键 词：老年患者 腰丛-坐骨神经阻滞 腰麻 膝关节置换 

分 类 号：R614.32[医药卫生—麻醉学] R684[医药卫生—外科学]