超声引导坐骨神经和股神经阻滞在老年患者膝部以下手术中的应用  

Application of ultrasound guided sciatic nerve and femoral nerve block in the operation of below the knee in elderly patients

作　　者：胡小玲[1] 杨小敏[1] HU Xiaoling;YANG Xiaomin(Department of Anesthesiology,Cancer Hospital of Jiangxi Province,Nanchang 330029, China)

机构地区：[1]江西省肿瘤医院麻醉科,江西南昌330029

出　　处：《中国现代医生》2019年第8期126-130,共5页China Modern Doctor

基　　金：江西省卫生计生委科技计划(20155517)

摘　　要：目的观察超声引导下坐骨神经和股神经阻滞在老年患者膝部以下手术的麻醉效果。方法 150例择期膝部以下手术的老年患者,随机分为超声引导坐骨神经和股神经阻滞组(A组)和硬膜外阻滞组(B组),每组75例。记录两组麻醉前5 min及麻醉后5、10、20、30、60 min的心率、收缩压、舒张压、脉搏血氧饱和度及感觉阻滞起效时间、感觉阻滞及运动阻滞维持时间、感觉阻滞及运动阻滞的阻滞程度、麻醉效果等。结果观察期两组的心率、脉搏血氧饱和度比较差异无统计学意义(P>0.05)。麻醉前两组收缩压、舒张压比较差异无统计学意义;B组麻醉后20、30 min的收缩压、舒张压低于麻醉前5 min,差异有统计学意义(P<0.05)。B组麻醉后20、30 min的收缩压及麻醉后20、30、60 min舒张压与A组比较差异有统计学意义(P<0.05)。A组神经阻滞起效时间短于B组,差异有统计学意义(P<0.05),A组感觉阻滞、运动阻滞维持时间长于B组,差异有统计学意义(P<0.05)。A组胫神经感觉阻滞效果优于B组,差异有统计学意义(P<0.05),两组运动阻滞效果差异无统计学意义(P>0.05)。A组麻醉效果优与B组,差异有统计学意义(P<0.05)。结论与硬膜外阻滞相比,超声引导下坐骨神经和股神经阻滞在老年患者膝部以下手术血流动力学更稳定,阻滞起效快,感觉阻滞效果、麻醉效果更优,感觉阻滞、运动阻滞维持时间更长。Objective To observe the anesthetic effect of ultrasound-guided sciatic nerve and femoral nerve block in the below the knee surgery of elderly patients. Methods A total of 150 elderly patients undergoing elective below the knee surgery were randomly divided into ultrasound-guided sciatic nerve and femoral nerve block group(group A) and epidural block group(group B), with 75 cases in each group. The heart rate, systolic blood pressure, diastolic blood pressure, pulse oximetry and sensory block onset time, sensory block and exercise block maintenance time, the degree of blockade of sensory block and motor block, anesthesia effect of two groups were recorded at 5 minutes before anesthesia and 5, 10, 20, 30, 60 minutes after anesthesia. Results There was no significant difference in heart rate and pulse oximetry between the two groups during the observation period(P>0.05). There was no significant difference in systolic and diastolic blood pressure between the two groups before anesthesia. The systolic blood pressure and diastolic blood pressure at 20 and 30 min after anesthesia in group B were lower than those at 5min before anesthesia, and the difference was significant(P<0.05). The systolic blood pressure in group B at 20 and 30 minutes after anesthesia and the diastolic blood pressure at 20, 30, and 60 minutes after anesthesia were significantly different from that in group A (P<0.05). The onset time of group A nerve block was shorter than that of group B(P<0.05). The maintenance time of sensory block and motor block in group A was longer than that in group B(P<0.05). The sensory block effect of sacral nerve in group A was better than that in group B, and the difference was significant(P<0.05). There was no significant difference in the exercise block effect in two groups(P>0.05).The anesthetic effect of group A was significantly different from that of group B(P<0.05). Conclusion Compared with epidural block, ultrasound-guided sciatic nerve and femoral nerve block has more stable hemodynamics, fast block onset, b

关 键 词：超声 坐骨神经阻滞 股神经阻滞 老年 

分 类 号：R614[医药卫生—麻醉学]