腰丛-坐骨神经阻滞麻醉与腰硬联合麻醉用于膝关节置换手术的效果比较

①目的比较腰丛-坐骨神经联合阻滞麻醉和腰硬联合麻醉对于膝关节置换手术生命体征的影响和麻醉效果的差异。②方法择期行膝关节置换手术的患者60例，随机分为两组，每组30例。A组为腰丛-坐骨神经阻滞麻醉组，B组为腰硬联合麻醉组。A组采用神经刺激仪器定位技术，于腰丛给予0．33％罗哌卡因30mL，坐骨神经给予0．33％罗哌卡因20mL；B组选择13，4间隙入路穿刺，给予0．5％的罗哌卡因2mL。观察两组患者阻滞后心率、血压、变化及感觉神经阻滞效果、运动神经阻滞效果。⑧结果A组的血流动力学较B组稳定，而两组麻醉方法的起效时间，阻滞效果无显著差异，术后不良反应的发生率A组较B组少见。④结论PNS定位下行腰丛-坐骨神经联合阻滞应用于下肢骨科手术，对血流动力学影响小，起效迅速，麻醉效果较完善，术后并发症少，是膝关节置换手术一种较为适合的麻醉方法。

Comparation of efficacy between combined lumbar plexus- sciatic nerve block and spinal-epidural anesthesia in the knee joint replacement operation

Objective To compare the effect of life sign and the difference of anesthesia efficacy between combined lumbar plexus-sciatic nerve block and spinal-epidural anesthesia in the knee joint replacement operation.Methods 60 patients with knee joint replacement operation were randomly divided into group A and B with 30 cases each.Patients in group A were assigned to receive lumbar plexus block using 0.33% ropivacain 30 ml and sciatic nerve block 0.33% ropivacain 20 ml by peripheral nerve stimulator(PNS),while spinal-epidural anesthesia were performed in patients of group B at L3-4 interspace with 0.5% ropivacain 2ml.The changes of heart rate and blood pressure and the blockade effects of sensory and motornerve were observed.Results The hemodynamics in group A was more stable than that in group B,while there was no significant difference in the working time and the blockade effect between two group,but the rate of side reaction in group A was less than that group B.Conclusion The combined lumbar plexus-sciatic nerve block was a good anesthesia method for patients with knee joint replacement operation,which was a stable hemodynamic responses and fewer complication.