超声引导下腰丛-坐骨神经阻滞与硬膜外麻醉用于老年膝关节置换术对比研究  

Comparative study of ultrasound-guided lumbar plexus-sciatic nerve block and epidural anesthesia for knee replacement in elderly

作　　者：刘宏飞[1] 霍鹏伟 LIU Hongfei;HUO Pengwei(Department of Anesthesiology,the Second Hospital of Yulin City,Shaanxi Province,Yulin 719000)

机构地区：[1]陕西省榆林市第二医院麻醉科,榆林719000

出　　处：《陕西医学杂志》2020年第8期947-950,共4页Shaanxi Medical Journal

基　　金：陕西省卫生科研基金资助项目(2018F84)。

摘　　要：目的:比较超声引导下腰丛-坐骨神经阻滞及硬膜外麻醉用于老年膝关节置换术的临床效果。方法:行膝关节置换术治疗的患者94例,采用简单抽样法将其分为观察组及对照组,各47例。对照组给予硬膜外麻醉,观察组给予超声引导下腰丛-坐骨神经阻滞。比较两组麻醉优良率;比较两组患者麻醉前及麻醉后6、12、24 h的Ramsay镇静评分(RSS);比较两组患者麻醉前、阻滞后10 min、阻滞后30 min、阻滞后60 min的血流动力学指标[心率(HR)、收缩压(SBP)、舒张压(DBP)];比较两组手术时间、术中出血量、术中液体量、术后首次进食时间、首次下床时间;统计患者术后5 d嗜睡、头晕等不良反应总发生情况。结果:观察组麻醉优良率高于对照组,术中出血量、术中液体量少于对照组,术后首次进食时间短于对照组(P<0.05);观察组麻醉后6、12 h的RSS评分均低于对照组(P<0.05);观察组阻滞后10、30 min的HR大于对照组,SBP、DBP高于对照组(P<0.05);观察组不良反应总发生率低于对照组(P<0.05)。结论:在超声引导下,应用腰丛-坐骨神经阻滞对老年膝关节置换术患者进行麻醉,可提高麻醉及镇静效果,改善血流动力学,减少术后不良反应。Objective:To compare the clinical curative effect of ultrasound-guided lumbar plexus-sciatic nerve block and epidural anesthesia for knee replacement in elderly.Methods:94 patients were divided into observation group and control group by simple sampling method,with 47 cases in each group.The control group was given epidural anesthesia,while the observation group was given ultrasound-guided lumbar plexus-sciatic nerve block.The excellent and good rate of anesthesia,scores of Ramsay sedation scale(RSS)before anesthesia and at 6,12 and 24 hours after anesthesia,hemodynamic indexes[heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)]before anesthesia,at 10,30 and 60 minutes after block,operation time,intraoperative blood loss,intraoperative fluid volume,postoperative first eating time and first leaving bed time were compared between the two groups.The total incidence of drowsiness,dizziness and other adverse reactions at 5 days after surgery was statistically analyzed.Results:The excellent and good rate of anesthesia in the observation group was higher than that in the control group,intraoperative blood loss and intraoperative fluid volume were less than those in the control group,and postoperative first eating time was shorter than that in the control group(P<0.05).At 6 and 12 hours after anesthesia,RSS scores in the observation group were lower than those in the control group(P<0.05).At 10 and 30 minutes after block,HR in the observation group was greater than that in the control group,SBP and DBP were higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion:The application of ultrasound-guided lumbar plexus-sciatic nerve block for knee replacement in elderly patients can improve anesthesia and sedation effect,improve hemodynamics,and reduce postoperative adverse reactions.

关 键 词：超声 腰丛-坐骨神经阻滞 硬膜外麻醉 膝关节置换术 镇静 血流动力学 

分 类 号：R614.4[医药卫生—麻醉学]