腰丛-骶旁坐骨神经阻滞联合静脉麻醉在髋部手术中的临床应用

目的：观察腰丛-骶旁坐骨神经阻滞联合异丙酚静脉麻醉用于髋部手术的麻醉及术后镇痛的临床效果.方法：择期行单侧髋部手术患者40例,随机分为腰丛-骶旁坐骨神经阻滞联合异丙酚静脉麻醉组（B组）和全身麻醉组（G组）,每组20例.B组和G组分别采用腰丛-骶旁坐骨神经阻滞联合异丙酚静脉麻醉和气管插管全身麻醉完成手术,术后2组患者均行电子自控静脉泵吗啡镇痛.记录2组患者术后0、3、6、12、24和48 h的活动和静息视觉模拟评分法（VAS）评分,吗啡用量及术后48 h内呕吐、瘙痒和尿潴留发生的例数.结果：B组患者在术后0、3、6 h的静息和运动VAS评分显著低于G组（P＜0.05）;B组术后第1天、第2天的吗啡用量,术中异丙酚及芬太尼用量均少于G组（P＜ 0.05）;2组患者瘙痒、恶心呕吐、术后咽痛的发生率差异有统计学意义（P＜o.05）.结论：腰丛-骶旁坐骨神经阻滞联合异丙酚静脉麻醉用于髋部手术的麻醉及术后镇痛效果确切,减少阿片类用药的同时,降低麻醉并发症的发生率,提高临床麻醉安全性,值得临床推广.

The clinical application of lumber plexus-paravertebral sciatic nerve block combined with intravenous anesthesia for hip fracture repair

Objective：To evaluate the clinical efficacy of lumber plexus-paravertebral sciatic nerve block combined with intravenous anesthesia as an anesthetic technique for hip fracture repair.Methods：Forty patients scheduled for hip fracture repair were randomly devided into two groups：Lumbar plexus-sciatic nerve block combined with propofol intravenous anesthesia group （B group） and intravenous general anesthesia group （G group）.The B group received the lumbar plexus-sciatic nerve block combined with propofol intravenous anesthesia,and the G group received the intravenous general anesthesia.Both groups received a patient-controlled intravenous analgesia after the operaion.Visual analog scale （VAS）,morphine requirements and the side effects （vomiting,pruritus and urinary retention） were recorded.Results：After hip fracture repair,the RVAS （rest visual analog scale） and the PVAS （passive VAS） scores of 0 h,3 h and 6 h in the B group were significant lower than that in G group （P＜0.05）.The morphine requirement in the first day,second day after the operaion and the fentanyl and propofol consumption during the operaion in B group were reduced significantly than that in G group （P＜0.05）,the difference of associated side effects （vomiting,pruritus and sore throat） between two groups was statistically significant （P＜0.05）.Conclusion：Lumbar plexus-paravertebral sciatic nerve block combined with propofol intravenous provides reliable anesthesia and analgesia,reduces morphine requirement and side effects after hip surgery.