腰丛-腰椎旁神经阻滞用于老年患者股骨头置换术的临床观察

目的：探讨神经刺激仪引导腰丛-腰椎旁神经阻滞用于老年患者股骨头置换术的麻醉效果、安全性及术后镇痛药物用量。方法选取2008年12月~2012年12月在北京航天总医院行股骨头置换术患者共62例（A组29例，男20例，女9例；B组33例，男21例，女12例），A组（研究组）应用腰丛-腰椎旁神经阻滞复合丙泊酚4~6 mg/（kg·h）]＋芬太尼0.0015~0.0020 mg/（kg·h）]静脉镇静，B组（对照组）应用单次蛛网膜下腔麻醉复合丙泊酚4~6 mg/（kg·h）]＋芬太尼0.0015~0.0020 mg/（kg·h）]静脉镇静；两组均用盐酸托烷司琼5 mg＋盐酸丁丙诺菲（0.015~0.020 mg/kg）复合液静脉术后镇痛，镇痛泵为驼人医疗器械集团生产的100 mL自控泵。比较两组老年患者股骨头置换术的麻醉效果、安全性及术后镇痛药物用量。结果 A组和B组进行以下指标比较：血压、心率差异无统计学意义（P〉0.05）；术中静脉镇静药物用量研究组为（42.80±8.27）mL，对照组为（20.23±1.57）mL，差异有统计学意义（P〈0.05）；术后镇痛追加的次数研究组为（6.00±1.54）次，对照组为（12.80±3.87）次，差异有统计学意义（P〈0.05）。结论神经刺激仪引导腰丛-腰椎旁神经阻滞用于老年患者股骨头置换术的麻醉效果可靠、安全，术后镇痛效果比单次蛛网膜下腔麻醉满意。

Clinical observation of femoral head replacement for elderly patients by lumbar plexus-paravertebral nerve block

Objective To explore anesthesia efficacy, safety and postoperative analgesic dose for femoral head replace-ment to elderly patients of the lumbar Plexus-paravertebral nerve block by neural Stimulator. Methods 62 cases with femoral head replacement （29 cases of group A, male 20 cases, female 9 cases;33 cases of group B, male 21 cases, fe-male 12 cases） in Beijing Aerospace General Hospital from December 2008 to December 2012 were collected, group A by the lumbar Plexus-paravertebra nerve block combined with propofol 4-6 mg/（kg·h）]＋fentanyl 0.0015-0.0020 mg/（kg·h）] intravenous sedation, group B spinal anesthesia combined with propofol 4-6 mg/（kg·h）] ＋ fentanyl 0.0015-0.0020 mg/（kg·h）] intravenous sedation; Tropisetron hydrochloride Glucose Injection 5 mg ＋ Buprenorphine Hydrochlo-ride Injection （0.015-0.020 mg/kg） were used by two groups for postoperative analgesia, Tuo ren medical devices group production of 100 mL controlled pump. Anesthesia efficacy, safety and postoperative analgesic dose for femoral head re-placement to elderly patients were compared. Results The results of group A and group B were compared： differences of blood pressure and heart rate had no statistics meaning （P 〉 0.05）, dosage of sedation drug： differences between group A and group B were （ 42.80±8.27）, （20.23±1.57） mL （P〈 0.05）, postoperative analgesia append of number： dif-ferences between group A and group B were （6.00±1.54）, （12.80±3.87） times （P〈 0.05）. Conclusion Effects of lumbar Plexus-paravertebral nerve block by neural stimulator of femoral head replacement for elderly patients in anesthesia is reliability security, postoperative analgesia is satisfied than spinal anesthesia group.