摘要
目的观察神经刺激仪引导下连续外周神经阻滞用于下肢术后镇痛的效果。方法 90例择期行单侧下肢手术的患者,随机均分为：神经刺激仪引导下连续外周神经阻滞镇痛组（N组）,连续硬膜外镇痛组（E组）,连续静脉给药镇痛组（I组）。N组麻醉前根据手术情况选择适当的下肢神经在刺激仪的引导下定位、穿刺留置导管;E组麻醉前行腰段（L3~4）硬膜外穿刺留置导管。三组患者麻醉方法及用药相同,手术结束前10min,N组经留置导管推注0.2%罗哌卡因15ml;E组经留置导管推注0.2%罗哌卡因10ml,I组静脉推注地佐辛5mg后接镇痛泵,配方分别为：N组0.2%罗哌卡因;E组0.2%罗哌卡因与0.5μg/ml舒芬太尼混合液;I组1.0μg/ml舒芬太尼。记录麻醉前（T0）、术后1h（T1）、4h（T2）、12h（T3）、24h（T4）、48h（T5）的SBP、DBP、HR、SpO2、VAS评分和Ramsay镇静评分及不良反应发生情况。结果与I组比较,N组和E组术后T1~T5时VAS评分明显降低（P〈0.05）;T1~T3时Ramsay镇静评分明显升高（P〈0.05）。与T0和N组比较,T1~T3时E组SBP、DBP明显下降（P〈0.05）。与N组比较,E组和I组恶心呕吐、瘙痒发生率也明显升高（P〈0.05）;E组的尿潴留发生率也明显升高（P〈0.05）。三组头晕、运动阻滞发生率差异无统计学意义。结论神经刺激仪引导下连续外周神经阻滞用于下肢手术后镇痛简便、安全、镇痛完善且不良反应少,值得临床推广。
Objective To observe the analgesic effect of nerve stimulator guided continuous peripheral nerve block.Methods Ninety patients received elective lower limb surgery were randomly divided into three groups：nerve stimulator guided continuous peripheral nerve block group（groupN）,continuous epidural block group（group E）,intravenous infusion of sufentanil group（group I）.The patients in group N received puncture and cathetering of lower limbs nerve by nerve stimulator guided.The patients in group E recerved puncture and cathetering of lumber epidural space（L3-4）.patients in group N received patient controlled analgesia with 0.2%ropivacaine,and group E with epidural 0.2%ropivacaine and sufentanil（0.5μg/ml）,and group I with intravenous sufentanil（1.0μg/ml）immediately when they were awake.They vital signs,VAS pain scores,Ramsay scores,at 1,4,12,24,48 h postoperatively were recorded.The side effects were recorded.Results The VAS scores in group N and group E at every time points were significantly lower than those in group I（P〈0.05）.Ramsay scores in group N at 1,4,12 hpostoperatively were lower than those in group I（P〈0.05）.The systolic and diastolic blood pressures in group N were smoother than those in group E（P〈0.05）.group N had lower nausea,vomiting and pruritus than groups E and I（P〈0.05）.Groups N and I had lower urinary retention than group E（P〈0.05）.Conclusion Nerve stimulator guided continuous peripheral nerve block can significantly reduce the lower limb post-surgery pain with less side effects and can be used easily and safely for analgesia of lower limb surgery.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2014年第10期1008-1011,共4页
Journal of Clinical Anesthesiology
关键词
神经刺激仪
下肢手术
连续外周神经阻滞
硬膜外镇痛
静脉镇痛
Nerve stimulator
Lower limb surgery
Continuous peripheral nerve block
Epidural analgesia
Intravenous analgesia
