摘要
目的比较超声引导下短轴平面内技术与长轴平面外技术在全髋关节置换术中行腰丛神经阻滞的操作便捷性、阻滞效果及不良反应。方法选择美国麻醉医师学会分级Ⅰ～Ⅲ级择期行全髋关节置换术的患者150例,年龄24～86岁,随机分入两组,每组75例,分别在超声引导下采用短轴平面内和长轴平面外技术进行腰丛神经阻滞。记录两组的图像定位时间和穿刺时间,测试股神经、股外侧皮神经、闭孔神经和坐骨神经的感觉阻滞程度,评估膝关节运动阻滞程度,观察患者是否发生双侧阻滞及不良反应发生情况。结果长轴平面外组的图像定位时间为(29.20±14.47)s,显著短于短轴平面内组的(39.20±25.79)s(P<0.05),两组间穿刺时间、总操作时间及术后股神经感觉恢复时间的差异均无统计学意义(P值均>0.05)。注射药物后30min,两组间股神经、股外侧皮神经、闭孔神经和坐骨神经有效阻滞的比例,双侧阻滞的比例,以及膝关节运动阻滞达0～2级者的比例的差异均无统计学意义(P值均>0.05)。除长轴平面外组有1例患者注射药物后主诉头晕、眼花外,两组均无神经损伤和其他不良反应。两组患者和术者的满意度均为2级或3级,差异均无统计学意义(P值均>0.05)。结论长轴平面外和短轴平面内这两种超声引导技术都能获得良好的腰丛神经阻滞效果,但长轴平面外技术所需的图像定位时间更短。
Objective To observe the clinical outcomes of ultrasound-guided lumbar plexus block in the patients with total hip replacement when in-plane technology with vertical scan or out-of-plane technology with longitudinal scan was used. Methods Totally 150 patients （aged 24- 86 years, American Society of Anesthesiologists grade I - III ） scheduled for total hip replacement were randomized into 2 groups （n = 75）. They received ultrasound-guided nerve block of lumbar plexus either by out-of-plane technology with longitudinal scan or by in-plane technology with vertical scan. The duration of image acquisition and puncture were recorded. Sensory block was tested in the distributions of femoral, lateral femoral cutaneous, obturator and sciatic nerves. Knee movement was assessed by the modified knee motion score. The incidences of bilateral block and other adverse reactions were also observed. Results The image acquisition time was significantly shorter in out-ofplane group than that in in-plane group （[29.20± 14.47] s vs. ;39. 20 ± 25. 79] s, P〈0. 05）. There was no significant difference in the puncture time, the total operation time or the sensory recovery time of femoral nerve between the two groups （all P〉0.05）; neither were there differences in the effective block of femoral, lateral femoral cutaneous, obturator and sciatic nerves, the incidence of bilateral block, and the 0 to 2 score rates of motor block of the knee between the two groups at 30 mins after nerve block （all P〉0. 05）. There was no nerve injury and other adverse reactions except that one patient who complained of dizziness after anesthesia in out-of-plane group. The satisfaction degree of the patients and the operators reached 2 or 3 degree and there was no difference between the two groups （all P〉0.05）. Conclusion Both methods of ultrasonic puncture can provide good nerve block of lumbar plexus, but it is easier to acquire image by out-of-plane technology with longitudinal scan than by in-plane technology with vertical scan.
出处
《上海医学》
CAS
CSCD
北大核心
2012年第12期991-993,I0001,共4页
Shanghai Medical Journal
关键词
超声
腰丛
全髋关节置换术
短轴平面内技术
长轴平面外技术
Ultrasound
Lumbar plexus
Total hip replacement
In-plane technology with vertical scan
Out-of-plane technology with longitudinal scan
