神经刺激器定位下腰丛-坐骨神经阻滞应用于老年患者膝关节部位手术的效果评价

目的比较神经刺激器(PNS)定位下腰丛-坐骨神经阻滞和硬膜外麻醉用于老年患者单侧膝关节部位手术的麻醉效果及对血液动力学的影响。方法选择40例行单侧膝关节部位手术的老年患者,ASAⅡ～Ⅲ级,分为A组(腰丛-坐骨神经联合阻滞组)、B组(硬膜外麻醉组)各20例,观察并纪录两组麻醉前及麻醉后5、10、20、30、60分钟的平均动脉压(MAP)和心率(HR),感觉运动神经阻滞的起效、完善及维持时间,以及局麻药和辅助药物用量、术中输液量、术中及术后不良反应等指标。结果术中所有患者都获得满意的麻醉效果,A组患者的感觉及运动神经阻滞起效时间均快于B组(P0.05),维持时间也长于B组(P0.05),整个麻醉过程中的MAP、HR均无显著性变化(P0.05);B组患者注药后5分钟的MAP与麻醉前比较无显著性变化(P0.05),而20、30、60分钟的MAP较麻醉前及注药后5分钟均显著降低(P0.05),整个麻醉过程中HR均无显著性变化(P0.05),B组术中输液量、术后尿潴留发生率及血管活性药使用率均显著高于A组(P0.05)。结论与硬膜外麻醉相比较,PNS定位下行单侧腰丛联合坐骨神经阻滞安全有效,对血液动力学影响小,术后不良反应少,镇痛时间长,有利于术后早期恢复,更适用于老年患者的单侧膝关节部位手术。

Lumbar plexus and sciatic nerve block in knee surgery of aged patients by nerve stimulator

Objective To compare the anesthesia efficacy between lumbar plexus combined with sciatic nerve block by peripheral nerve stimulator （PNS） and epidural anesthesia for the aged undergoing unilateral knee surgery,and the two methods＇ impact on hemodynamics.Methods Forty aged patients undergoing unilateral knee surgery,in ASA Ⅱ ~ Ⅲ grade,were randomly divided into two groups with 20 cases in each group.Lumbar plexus and sciatic nerve block by PNS were used in group A,while epidural anesthesia was used in group B.Mean arterial blood pressure （MAP） and heart rate （HR） of the two groups were monitored before and 5,10,20,30,60 minutes after anesthesia.The onset time and duration of both motor and sensory block of the two groups were recorded.Indicators like local anesthetics and ancillary drug dosage,fluid volume and adverse reactions were observed.Results All patients in two groups had satisfactory anesthesia.The onset and maintenance time of MAP in group A were faster than those in group B （P 0.05）.There were no significant changes in MAP and HR of group A during anesthesia （P 0.05）.There was no significant change in MAP of group B before and 5 minutes after anesthesia （P 0.05）.MAP in 20,30,60 minutes after anesthesia were significantly lower than that before anesthesia （P 0.05）.There was no significant change in HR of group B during anesthesia （P 0.05）.Fluid volume,incidence of urinary retention and usage of vasoactive drugs in group B were significantly higher than those in group A （P 0.05）.Conclusion Compared with epidural anesthesia,lumbar plexus and sciatic nerve block by PNS is safe and effective for the aged undergoing unilateral knee surgery for its less effects on hemodynamics,fewer adverse reactions,long time of analgesia and early recovery.