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三点法神经阻滞麻醉在老年患者下肢手术中的应用 被引量:9

The application of three-point nerve block anesthesia in old patients undergoing lower limb surgery
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摘要 目的比较神经刺激仪引导下的的腰丛-坐骨神经-股神经联合阻滞与硬膜外阻滞在老年患者下肢手术的临床效果。方法 110例ASAⅠ~Ⅲ级拟行下肢手术的老年患者,随机分为腰丛-坐骨神经-股神经联合阻滞组(A组,n=55)和硬膜外阻滞组(B组,n=55),记录两组患者麻醉前、手术开始时和手术结束时血压和心率的变化。观察两组患者感觉和运动阻滞的起效时间、持续时间及阻滞效果。结果手术开始时B组患者的血压明显降低,心率增快,并持续至手术结束以后(P<0.05),而A组患者均无明显变化(P>0.05)。A组患者感觉和运动阻滞的起效时间明显短于B组,感觉和运动阻滞的维持时间明显长于B组(P<0.05)。两组患者的麻醉效果无明显差异(P>0.05),术中均未出现止血带疼痛现象。结论神经刺激仪引导下的三点法神经阻滞麻醉具有血流动力学稳定、镇痛完善持久和并发症少等优点,适合用于老年患者的下肢手术。 【Objective】 To compare the anesthetic effect between lumbar plexus-sciatic-femoral plexus nerve block guided by nerve stimulator and epidural block in old patients undergoing lower limb surgery.【Methods】 110 old patients,ASA physical status of Ⅰ~Ⅲ,undergoing lower limb surgery were allocated into two groups: lumbar plexus-sciatic-femoral plexus nerve block group(A group,n =55) and epidural block group(B group,n =55).The change of blood pressure and the heart rate was recorded before two groups of patients are anaesthetized,when operations begin and over.Up-effect time and sustained time of feeling and motion block,block effect of two groups of patients were observed.【Results】 The blood pressure reduced obviously and heart rate increased quickly when operation begun in the B group,and it continued until operation was over(P 0.05),but the change was not obvious in the A group(P 0.05).The up-effect time of feeling and motion block was shorter obviously,the sustained time of feeling and motion block was longer in the A group than in the B group(P 0.05).Anaesthesia effect of two groups of patients had no obvious difference(P 0.05).The pain arousing from the tourniquet didn't appear during the operations.【Conclusion】 The three-point nerve block anesthesia guided by nerve stimulator with stabile blood flow mechanics,consummate anaesthesia effect and less complication is fit to the old patients undergoing lower limb surgery.
作者 陈璟莉 严虹
出处 《中国现代医学杂志》 CAS CSCD 北大核心 2011年第22期2808-2810,2813,共4页 China Journal of Modern Medicine
关键词 神经刺激仪 腰丛-坐骨神经-股神经联合阻滞 硬膜外阻滞 老年患者 下肢手术 nerve stimulator lumbar plexus-sciatic-femoral plexus nerve block epidural block old patients lower limb surgery
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参考文献6

  • 1徐仲煌,黄宇光,潘华,陈绍辉,任洪智,叶铁虎,罗爱伦.罗比卡因用于腰丛-坐骨神经联合阻滞的临床观察[J].临床麻醉学杂志,2002,18(5):235-238. 被引量:128
  • 2JACQUES EC. Peripheral Nerve Blocks [M]. Baltimore: Williams and Wikins, 1999: 7-10.
  • 3CASATI A, FANELLI G, TORRI G, et al. Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks[J]. Anesthesi- ology, 1999, 90: 1047-1053.
  • 4MANUEL T, JULIAN A, JOAQUIN C, et al. The effects of three different approaches on the onset time of sciatic nerve blocks with 0.75% ropivacaine[J]. Anesth Analg, 2004, 98: 242-247.
  • 5FANELLI G, CASATI A, GARANCINI P, et al. Nerve stimulator and multiple injections technique for upper and lower limb blockade: failure rate, patient acceptance and neurologic compli- cations[J]. Anesth Analg, 1999, 88: 847-852.
  • 6薛飞,张小洺,杨东,姚尚龙.外周神经阻滞在单侧大隐静脉曲张手术中的应用[J].临床麻醉学杂志,2005,21(11):779-780. 被引量:23

二级参考文献11

  • 1刘俊杰 赵俊.现代麻醉学(第2版)[M].北京:人民卫生出版社,1999.686-709.
  • 2李功宋(译) 李佳音 等.体外循环中的内分泌、体液及代谢反应.体外循环灌注学[M].北京:人民卫生出版社,1993.176.
  • 3Fanelli G, Casati A, Garancini P, et al. Nerve stimulator and multiple injections technique for upper and lower limb blockade:failure rate, patient acceptance and neurologic complications.Anesth Analg, 1999, 88: 847-852.
  • 4Grant SA, BresLin DS, MacLeod DB, et al. Variability in determination of point of needle insertion in peripheral nerve blocks: a comparison of experienced and inexperienced anaesthetists. Anaesthesia, 2003, 58: 688-692.
  • 5Parkinson SK, Mueller JB, Little WL, et al. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg,1989, 68:243-248.
  • 6Gaertner E, Lascurain P, Venet C, et al. Continuous parasacral sciatic block: a radiographic study. Anesth Analg, 2004, 98:831-834.
  • 7Taboada M, Rodriguez J , ALvarez J , et al. Sciatic nerve block via posterior labat approach is more efficient than lateral popliteal approach using a double-injection technique: a prospective, randomized comparison. Anesthesiology, 2004, 101:138-142.
  • 8Fanelli G, Casati A, Beccaria P, et al. A double-blind comparison of ropivacaine , bupivacaine, and mepivacaine during sciatic and femoral nerve blockade. Anesth Analg, 1998, 87: 597-600.
  • 9Casati A, Fanelli G,Borghi B,et al. Ropivacaine or 2% mepivacaine for lower limb peripheral nerve blocks. Study Group on Orthopedic Anesthesia of the Italian Society of Anesthesia, Analgesia, and Intensive Care. Anesthesiology, 1999,90:1047-1053.
  • 10Taboada M, ALvarez J, Cortes J, et al. The effects of three different approaches on the onset time of sciatic nerve blocks with 0.75% ropivacaine. Anesth Analg,2004, 98:242-247.

共引文献145

同被引文献89

  • 1洪彪,田卓平,张培华.下肢静脉曲张发病机理研究近况[J].中国现代普通外科进展,2006,9(4):196-198. 被引量:16
  • 2Nader A,Malik K,Kendall MC. Relationship between ultrasound imaging and eliciting motor response during femoral nerve stimulation[J].{H}Journal of Ultrasound in Medicine,2009,(3):345-350.
  • 3Gandhi K,Lindenmuth DM,Hadzic A. The effect of stimulating versus conventional perineural catheters on postoperative analgesia following ultrasound-guided femoral nerve localization[J].{H}JOURNAL OF CLINICAL ANESTHESIA,2011,(8):626-631.
  • 4Hayashi H,Ueyama H. Experience of ultrasound-guided popliteal sciatic nerve block and femoral nerve perineural catheter placement in a morbidly obese patient undergoing total knee arthroplasty[J].{H}Masui Japanese Journal of Anesthesiology,2010,(10):1260-1262.
  • 5Wegener JT,van Ooij B,van Dijk CN. Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty:a prospective,randomized,controlled trial[J].{H}Regional Anesthesia and Pain Medicine,2011,(5):481-488.
  • 6Lewis C,Gunta K,Mitchell K. Effectiveness of multimodal pain management protocol in total knee arthroplasty patients[J].{H}Orthopedic Nursing,2012,(3):153-159.
  • 7Maheshwari AV,Blum YC,Shekhar L. Multimodal pain management after total hip and knee arthroplasty at the ranawat orthopaedic center[J].{H}Clinical Orthopaedics and Related Research,2009,(6):1418-1423.
  • 8Salinas FV,Liu SS,Mulroy MF. The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway[J].{H}Anesthesia and Analgesia,2009,(4):1234-1239.
  • 9Campbell A,McCormick M,McKinlay K. Epidural vs.lumbar plexus infusions following total knee arthroplasty:randomized controlled thal[J].{H}European Journal of Anaesthesiology,2008,(6):502-507.
  • 10Murray JM,Derbyshire S,Shields MO. Lower limb blocks[J].Anaesthsia,2010,(Suppl 1):57-66.

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