摘要
目的比较老年患者单侧下肢手术中c型臂引导下行腰丛联合坐骨神经阻滞与硬膜外麻醉的效果。方法选择60例ASAI～Ⅲ级拟行单侧下肢手术患者，根据随机余数法分为腰丛联合坐骨神经阻滞组（A组，n=30）和硬膜外麻醉组（B组，n=30），A组在C臂引导下行腰丛联合坐骨神经阻滞，两点分别给予0．375％罗哌卡因30ml（腰丛）、20ml（坐骨神经）；B组行硬膜外麻醉，给予0．375％罗哌卡因10-15ml。观察两组不同时点血流动力学变化、阻滞效果及其不良反应。结果A组在手术过程中的收缩压、舒张压、心率较B组平稳；A组用麻黄碱的患者显著少于B组（P〈0．01）；A组患者感觉神经阻滞起效时间长于B组（P〈0．01），但A组感觉神经及运动神经阻滞维持时间均明显长于B组（P〈0．01）；B组围术期出现恶心、呕吐、尿潴留不良反应明显高于A组（P〈0．01）。结论腰丛联合坐骨神经阻滞用于老年患者单侧下肢手术，不仅可满足手术需要，而且对老年患者血流动力学影响小，并发症少，镇痛维持时间长，不良反应少。尤其适合年老体弱患者的手术。
Objective To compare the effects of C-arm guided lumbar plexus and sciatic nerve blockade and epidural anesthesia on elderly patients with lower limb surgery. Methods Sixty elderly cases （ ASA Ⅰ-Ⅲ ） were di- vided into the lumbar plexus and sciatic nerve blockade group （ group A, n = 30） and the epidural anesthesia group （ group B, n = 30）. Patients in group A received C-arm guided lumbar plexus and sciatic nerve blockade, with 30 ml and 20 ml of 0. 375% ropivaeaine administrated to the lumbar plexus and sciatic nerve respectively; Patients in group B received epidural anesthesia and were administrated with 10 - 15 ml of 0. 375% ropivacaine. Hemodynamie chan- ges, the effects of blockade and adverse reactions were observed in both groups. Results The systolic pressure, dias-tolic pressure and heart rate in group A were more stable than those in group B. The number of patients using ephed- rine in group A was much smaller than that in group B（P 〈0.01 ）. The sensory block onset time of group A was lon- ger than that of group B（P 〈0.01）, while the hold time of sensory and motor nerve block onset time of group A was significantly longer than that of group B（P 〈0.01 ）. Adverse reactions such as nausea, vomit and retention of urine in group B during the preoperative period were much more severe than those in group A（ P 〈 0.01 ）. Conclusion The application of lumbar plexus and sciatic nerve blockade in unilateral lower limb surgery can not only meet the sur- gical requirements, but also have a small impact on hemodynamics, less complications, longer duration of pain relief and less adverse reactions. Therefore, it is especially suitable for frail elderly patients.
出处
《中国临床新医学》
2015年第12期1153-1156,共4页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
