腰丛-坐骨神经阻滞在老年患者髋部手术中的应用

目的比较老年患者单侧髋部手术中神经刺激器定位下的腰丛-坐骨神经阻滞与硬膜外麻醉效果。方法50例ASAⅠ～Ⅲ级拟行单侧髋部手术老年患者，随机分为腰丛-坐骨神经阻滞组（A组，n=25）和硬膜外麻醉组（B组，n=25）。A组采用神经刺激器定位下的腰丛-坐骨神经阻滞，两点分别给予0．45％罗哌卡因30ml（腰丛）、20ml（坐骨神经）；B组行硬膜外麻醉，给予0．75％罗哌卡因10～15ml。观察2组血流动力学变化、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；2组感觉阻滞起效时间无显著差异（P〉0．05），但A组感觉阻滞维持时间明显长于B组（P〈0．05）；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〈0．05）。结论腰丛-坐骨神经阻滞用于老年患者单侧髋部手术不仅可满足手术需要，而且对血流动力学影响小，镇痛维持时间长，不良反应少。

Application of combined lumbar plexus and sciatic nerve block in hip surgery in elderly patients

Objective To compare the effects of combined lumbar plexus - sciatic nerve block guided by the nerve stimulator and epidural anesthesia in elderly patients undergoing unilateral hip surgery. Methods 50 elderly patients, ASA physical status Ⅰ - Ⅲ grade, designated for hip surgery were randomly divided into two groups （ n = 25 ） ： combined lumbar plexus - sciatic nerve block group （ group A） and epidural anesthesia group （ group B ）. In group A, combined lumbar plexus -sciatic nerve block guided by nerve stimulator was conducted, with 0.45% ropivacaine 30 ml （lumbar plexus） and 20 ml （sciatic nerve） administered respectively. In group B, epidural anesthesia was achieved by injection of 0.75% ropivacaine 10- 15 ml. The variations in hemodynamies, the effect of nerve block and adverse reactions in both groups were recorded. Results In group A, the systolic and diastolic pressures were more smooth and the patients on ephedrine was fewer, as compared to group B. There was no difference in the onset time of effective block between the two groups （ P 〉 0.05 ）, while the duration of effective block was longer in group A than that in group B （ P 〈 0.05 ）. The incidence of nausea, vomiting and urinary retention was markedly higher in group B than that in group A （P 〈 0. 05）. Conclusion Combined lumbar plexus - sciatic nerve block in unilateral hip surgery in elderly patients undergoing is well - suited and has advantages of less impact on hemodynamics, longer analgesia duration and fewer effect on hemodynamics and fewer adverse reactions.