超声引导下隐神经与坐骨神经联合阻滞在老年病人中的应用观察  

Ultrasound-guided approach for saphenous nerve combined sciatic nerve block in elderly patients

作　　者：赵以松[1] 徐中萍 沈劼颖 陈梅花[1] ZHAO Yi-song;XU Zhong-ping;SHEN Jie-ying;CHEN Mei-hua(Department of Anesthesiology,Suzhou Hospital of Traditional Chinese Medicine,Suzhou 215009,China)

机构地区：[1]苏州市中医医院麻醉科,江苏省苏州市215009

出　　处：《实用老年医学》2018年第8期744-747,共4页Practical Geriatrics

摘　　要：目的观察超声引导下隐神经与坐骨神经联合阻滞麻醉在老年踝关节骨折手术中的应用效果。方法选择进行单侧踝关节骨折内固定手术的老年病人60例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级。采用随机数字表法将病人随机分为2组:B组采用超声引导下隐神经与坐骨神经阻滞,A组采用腰麻;记录2组阻滞起效时间、阻滞维持时间、术中病人疼痛评分、芬太尼使用量及病人满意度;观察记录阻滞前(T0)、阻滞后10 min(T1)、30 min(T2)、术毕(T3)的平均动脉压(MAP)、心率(HR);观察记录2组病人不良反应。结果 2组病人在年龄、性别、体质量、ASA分级、手术时长方面差异无统计学意义。2组病人都顺利完成手术,手术区域阻滞效果完善,2组芬太尼使用量和术中疼痛评分差异无统计学意义。B组病人阻滞起效时间稍慢于A组(P<0.05),维持时间明显长于A组(P<0.01),且B组病人满意度比A组高(P<0.05)。术前T0点2组间血压、心率差异无统计学意义;A组病人MAP、HR在T2、T3时间点较T0有明显下降(P<0.05),B组病人各时间点间MAP、HR差异无统计学意义。A组低血压、恶心呕吐、尿潴留、腰背酸痛等不良反应发生率高于B组(P<0.05);结论超声引导下隐神经与坐骨神经联合阻滞应用于踝关节骨折手术,定位准确、操作简单、起效快、镇痛效果完善、血流动力学平稳,不良反应发生率低,病人满意度高,是一种较好的麻醉选择。Objective To observe the effect of the application of ultrasound-guided saphenous nerve combined sciatic nerve block in the operation of ankle fracture in the elderly patients. Methods Sixty elderly patients（ ASA Ⅱ-Ⅲ） with a single ankle fracture were selected. These patients were randomly divided into two groups（ n = 30） by random numbers table： spinal anesthesia group（ group A）and sciatic nerve combined saphenous nerve block group（ group B）. The nerve block onset time and the time of duration,dose of fentanyl and patients＇ satisfaction,intraoperative visual analog pain score（ VAS）,mean arterial pressure（ MAP） and heart rate（ HR） was recorded before anesthesia（ T0）,10 min（ T1） and 30 min（ T2） after block,and at the end of the operation（ T3）. The adverse reactions of patients were also recorded. Results There were no statistical differences between the two groups in age,gender,weight,ASA grading,duration of operation. The operation was successful in all the patients of the two groups,and the surgical area block effect,the use of fentanyl and intraoperation VAS were not statistically different between the two groups. Compared with group A,the onset time in group B was later,but the maintainable time of block was significantly longer（ P〈0. 01）. The patients＇ satisfaction in group B was higher than that in group A（ P〈0. 05） 24 h after surgery; The levels of MAP and HR in group A were significantly decreased at T2 and T3 time points compared with T0 point（ P〈0. 05）,while showed no significant difference between the time points in group B; The incidence of adverse reaction,such as hypotension,nausea and vomiting,urinary retention,low back pain and headache in group A was higher than that in group B（ P〈0. 05）. Conclusions The ultrasound-guided saphenous nerve combined sciatic nerve block is an good method in the ankle fracture surgery in the elderly,with accurate location,simple operation,fast effect and little adverse reactions.

关 键 词：超声引导 隐神经联合坐骨神经阻滞 老年人 

分 类 号：R614[医药卫生—麻醉学]