神经阻滞在老年患者单侧下肢手术中的应用

目的：探讨神经阻滞麻醉和椎管内麻醉对老年人单侧下肢手术的麻醉并发症的比较。方法：ASAⅠ～Ⅲ级拟行单侧下肢手术患者66例,年龄65～85岁,随机分为硬膜外组（E组）、神经阻滞组（NB组）。NB组又分两个亚组：腰丛联合坐骨神经阻滞组（S＋F组）和坐骨神经阻滞联合股神经阻滞组（F＋L组）,每组22例。S＋F组、F＋L组应用了神经刺激器定位进行神经阻滞,膝关节以下手术采用坐骨神经加股神经阻滞,髋关节和股骨干部位手术采用坐骨神经加腰丛阻滞。E组于L3,L4间隙穿刺,间断给利多卡因维持麻醉,平面控制在T10。记录各组患者在麻醉前,麻醉后15、306、0 min、术毕无创血压（BP）、心率（HR）及脉搏氧饱和度（SpO2）;记录麻醉起效时间（针刺法）,术后随访镇痛维持时间,患者运动阻滞时间;观察术中局麻药中毒、低血压的发生情况,及术后尿潴留恶心呕吐等并发症发生率。麻醉效果按“临床麻醉管理与技术规范”神经阻滞评级标准评定。结果：神经阻滞组血液动力学稳定,均顺利完成手术,并术后并发症少,镇痛维持时间长。结论：神经阻滞用于单侧下肢手术,老年患者术中循环功能稳定,阻滞效果完善,术后不良反应较少,术后可以早期活动,术后康复快,是一种安全而经济的麻醉方法。

Application of Nerve Blockade in Surgeries of Single Leg in Aged

Objective： To compare the complications of anesthesia between nerve blockade and intraspinal anesthesia in surgeries of single leg in aged. Methods： 66 eases for surgeries of single leg , who aged between 65 and 85 years old with ASA in grade Ⅰ to Ⅲ were randomly divided into group with epidural anesthesia （ E group） and group with nerve blockade（ NB group）. NB group was divided into two subgroups： S ＋ F group （n = 22） and F ＋ L group（n= 22）. NB group received nerve blockade located by nerve stimulator, sciatic nerve combined with femoral nerve blockade for surgery in inferior knee joint, or sciatic nerve combined with lumbar plexus blockade for surgery in hip joint and shaft of femur. E group received lidocayin through puncture between L3 and L, and controlling anesthesia in T10. Before anesthesia and at 15, 30, 60 min after anesthesia and ended time, the BP, HR and SpOz were observed. The onset time of anesthesia was recorded, and the duration of analgesia and residence time of motion was followed up. The occurrence of toxic effect and hypotension during operation and complications including urine retention and nausea and vomiting were observed. The efficacy of anesthesia was evaluated based on criteria of nerve blockade grading. Results： In NB group, the hemodynamics was steady. The surgeries were successful with less postoperative complications and better maintaining analgesia. Conclusion： Nerve blockade is safe and feasible technique for aged patients receiving surgies of single leg, with stable circulation, perfect anesthetic effect and less adverce effect and quick recovery.