超声联合神经刺激仪引导腰丛-坐骨神经阻滞在高龄股骨手术患者中的应用  

Application of lumbar plexus-sciatic nerve block guided by ultrasound combined with nerve stimulator in elderly patients undergoing femur surgery

作　　者：杨传信 鲍方 邓利兵 张美琴 张龙 周海洲 蒋晖 YANG Chuan-xin;BAO Fang;DENG Li-bing;ZHANG Mei-qin;ZHANG Long;ZHOU Hai-zhou;JIANG Hui(Department of Anesthesiology,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China;Department of Orthopedics,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]复旦大学附属中山医院青浦分院麻醉科,上海201700 [2]上海中医药大学附属龙华医院骨科,上海201203

出　　处：《局解手术学杂志》2020年第10期822-826,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨超声联合神经刺激仪引导腰丛-坐骨神经阻滞在高龄股骨手术患者中的应用效果。方法选取2017年2月至2019年7月复旦大学附属中山医院青浦分院收治的行股骨手术的高龄患者86例,根据患者意愿分为对照组(采用神经刺激仪引导腰丛-坐骨神经阻滞)和观察组(采用超声联合神经刺激仪引导腰丛-坐骨神经阻滞),每组43例。记录2组患者围手术期的收缩压、舒张压、心率、阻滞完成时间、阻滞起效时间、阻滞持续时间;比较2组患者视觉模拟疼痛(VAS)评分、Ramsay镇静评分、简易智能精神状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分及并发症发生率。结果患者麻醉前、麻醉后10 min、麻醉后30 min及术毕的收缩压、舒张压、心率组间及组内不同时间点间比较,差异均无统计学意义(P>0.05)。观察组阻滞完成时间、阻滞起效时间均短于对照组,阻滞持续时间长于对照组,差异均有统计学意义(P<0.05)。术后6 h、12 h、24 h,观察组VAS评分均低于对照组差异均有统计学意义(P<0.05)。术后6 h、12 h、24 h,2组患者Ramsay评分比较差异均无统计意义(P>0.05)。术后12 h,2组患者VAS评分均高于同组术后6 h,Ramsay评分均低于同组术后6 h,差异有统计学意义(P<0.05)。术后24 h,2组患者VAS评分和Ramsay评分均低于同组术后6 h、12 h,差异有统计学意义(P<0.05)。患者手术前后MMSE、MoCA评分组间比较,差异均无统计学意义(P>0.05),但术后MMSE、MoCA评分均低于同组术前,差异有统计学意义(P<0.05)。患者并发症发生率组间比较,差异无统计学意义(P>0.05)。结论超声联合神经刺激仪引导腰丛-坐骨神经阻滞应用于高龄股骨手术患者可以缩短阻滞完成时间和起效时间,延长阻滞持续时间,提高阻滞效果和术后镇痛效果,且不影响患者术中的血流动力学稳定和术后认知功能。Objective To explore the application of the lumbar plexus-sciatic nerve block guided by ultrasound combined with nerve stimulator in elderly patients undergoing femur surgery.Methods A total of 86 elderly patients who underwent femur surgery from February 2017 to July 2019 in Qingpu branch of Zhongshan hospital affiliated to Fudan university were selected and divided into the control group(using nerve stimulator to guide lumbar plexus-sciatic nerve block)and the observation group(using ultrasound combined with nerve stimulator to guide lumbar plexus-sciatic nerve block)according to their wishes,with 43 cases in each group.The systolic blood pressure,diastolic blood pressure,heart rate,block completion time,block onset time and block duration were recorded in the two groups during the perioperative period.Visual analogue pain scale(VAS),Ramsay sedation score(Ramsay),mini-mental state examination(MMSE)score,Montreal cognitive assessment(MoCA)score and complication rate were compared in the two groups.Results There was no statistically significant difference in systolic blood pressure,diastolic blood pressure and heart rate in the same group and between the two groups before anesthesia,10 minutes after anesthesia,30 minutes after anesthesia,and after the operation(P>0.05).The block completion time and block onset time in the observation group were shorter than those in the control group,and the block duration was longer than that in the control group,the differences were statistically significant(P<0.05).VAS scores in the observation group were lower than those in the control group at 6,12 and 24 hours after surgery(P<0.05).There was no statistically significant difference in Ramsay scores in the two groups at 6,12 and 24 hours after surgery(P>0.05).At 12 hours after surgery,the VAS scores of both groups were higher than those of the same group at 6 hours after surgery,and the Ramsay scores were lower than those of the same group at 6 hours after surgery(P<0.05).At 24 hours after surgery,the VAS scores and the Ramsa

关 键 词：股骨手术 超声 神经刺激仪 腰丛-坐骨神经阻滞 术后镇痛 

分 类 号：R445.1[医药卫生—影像医学与核医学] R614.4[医药卫生—诊断学]