超声引导下腰丛-坐骨神经阻滞在老年膝关节镜手术中的效果

目的 探讨超声引导下腰丛-坐骨神经阻滞在老年膝关节镜手术中的应用实效性.方法 选择80例老年择期行膝关节镜手术患者,按随机数字表法平均分为观察组和对照组各40例,观察组患者使用超声引导下腰丛-坐骨神经阻滞,对照组患者使用硬膜外麻醉,比较两组患者麻醉效果、感觉神经及运动神经阻滞情况、血流动力学变化及不良反应发生率.结果 观察组麻醉优良率为95.0％,对照组麻醉优良率为90.0％,两组比较,差异无统计学意义(χ2=0.62,P>0.05);两组感觉神经与运动神经麻醉起效时间比较,差异无统计学意义(t=1.874、1.189,P>0.05);两组感觉神经阻滞、运动神经阻滞、镇痛效果的持续时间比较,均差异有统计学意义(t=8.729、8.948、5.275,P<0.05);观察组患者血流动力学指标收缩压(SBP)、舒张压(DBP)及心率(HR)在麻醉各时期差异无统计学意义(P>0.05),对照组患者SBP及DBP在T2及T3时刻均较T0和T1时刻明显降低,差异有统计学意义(P<0.05),而且T2及T3下,两组SBP及DBP比较,对照组低于观察组,均差异有统计学意义(P<0.05);观察组不良反应发生率为7.5％,对照组不良反应发生率为40.0％,差异有统计学意义(χ2=11.67,P=0.001).结论 随着可视化技术在麻醉中推广应用,使得神经阻滞技术定位准确,麻醉完善,负影响小,对临床有一定指导意义.

Application effect of ultrasound guided lumbar plexus-sciatic nerve block in the elderly knee arthroscopic operation

Objective To investigate the application effectiveness of ultrasound guided lumbar plexus-sciatic nerve block in the elderly knee arthroscopic operation.Methods 80 cases of elderly patients undergoing knee arthroscopy operation were randomly divided into two groups with 40 cases in each group according to the number table methods.The study group used ultrasound guided lumbar plexus-sciatic nerve block and the control group patients used epidural anesthesia.The effect of anesthesia,sensory nerve and motor nerve block,hemodynamic changes and the incidence of adverse reactions of two groups of patients were compared.Results In the study group,the excellent and good rate of anesthesia was 95.0％,and the excellent rate of anesthesia in the control group was 90.0％.There was no statistically significant difference between two groups (χ2 =0.62,P >0.05).The response time of sensory nerve and motor after anesthesia (t =1 .874,1 .189,P >0.05)is with no statistically significant.Between the study group and the control group,sensory nerve block,analgesia effect time and duration of motor block were compared,whichwere significant difference (t =8.729,8.948, 5.275,P <0.05).The hemodynamic indexes of SBP,DBP and HR had no statistical significance in each period of anesthesia (P >0.05).In control group,data change of SBP and DBP in T2 and T3 were significantly lower than T0 and T1 ,and the difference was sta-tistically significant (P <0.05),and at T2 and T3,SBP and DBP changes were statistically significant between the study group and the control group (P <0.05),the control group was lower than the study group.The study group with adverse reaction rate was 7.5％,and the control group of patients with adverse reaction rate was 40％,with statistically significant differences (χ2 =11 .67.P =0.001 ). Conclusions Using ultrasound guided lumbar plexus and sciatic nerve block anesthesia for the elderly knee arthroscopic operation has an obvious effect,which can reduce the interference of anesthesia drugs on hemodynamics of the patients.