老年患者全髋关节置换术的腰丛-骶丛神经阻滞麻醉方法  

The lumber plexus and sacral plexus nerve block method of total hip arthroplasty for elder patients

作　　者：曹雪芹[1] 梅伟[1] 陈明兵[1] 刘九红[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《骨科》2016年第6期425-428,共4页ORTHOPAEDICS

摘　　要：目的 探讨改良的老年患者人工髋关节置换术的神经阻滞麻醉方法.方法 选取2015年3-6月于我院行全髋关节置换手术的14例老年患者,予腰丛-骶丛神经阻滞麻醉,术前运用针刺法测试麻醉平面,记录术中血流动力学变化、不良反应,评估麻醉效果.结果 臀上神经支配的阔筋膜张肌区域、臀下神经支配的臀大肌区域、股神经支配的股四头肌区域及坐骨神经支配的大腿后肌群区域皮肤痛觉消失.患者麻醉前即刻和切皮时收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、心率（heart rate,HR）值比较,差异均无统计学意义（均P〉0.05）.术中SBP、DBP和HR最大变化率分别为13.9%±6.2%、15.8%±7.8%和14.1%±4.8%,均在20%以内.所有患者均在单纯神经阻滞麻醉下顺利完成手术,术中均未追加阿片类药物.术中未出现局部麻醉药物中毒、血流动力学大幅波动、呼吸抑制等并发症.术者满意度评分均为10分.结论 本研究显示腰丛-骶丛神经阻滞麻醉可安全有效运用于老年患者人工髋关节置换术.受限于样本量,我们仍将在以后的临床工作中更进一步研究.Objective To explore an improved nerve block method for elder patients undergoing total hip arthroplasty. Methods Fourteen older patients scheduled for total hip arthroplasty from March to June of 2015 were given lumber plexus and sacral plexus nerve block. The block areas were tested with acupuncture. The hemodynamic changes before anesthesia and after skin incision were compared. The maximum change rate of hemodynamic changes during operation was observed. The perioperative adverse reactions and anesthesia satisfaction were also evaluated. Results The cutaneous pain of tensor fasciae latae innervated by superior gluteal nerve, gluteus maximus innervated by inferior gluteal nerve, quadriceps femoris innervated by femoral nerve and hamstrings innervated by sciatic nerve was insensible. There were no significant differences in the changes of systolic blood pressure, diastolic blood pressure, heart rate between after skin incision and pre-anesthesia （P〉0.05）. The variations of systolic blood pressure, diastolic blood pressure and heart rate were 13.9%± 6.2%, 15.8%± 7.8%, and 14.1%± 4.8%, respectively, which were less than 20%. The surgery was successfully completed in all patients under pure nerve block. There was no use of opiods. The patients didn＇t present local anesthetics poisoning, and circulating complications such as volatility, respiratory inhibition. The surgeons＇satisfaction about anesthetic effect was all 10 points. Conclusion Lumber plexus sacral plexus nerve block is a safe and effective anesthetic technique for total hip arthroplasty. Because of the small sample size, further study is needed.

关 键 词：神经传导阻滞 老年人 关节成形术 置换 髋 

分 类 号：R614[医药卫生—麻醉学]