超声引导下腰丛坐骨神经阻滞与腰硬联合麻醉在老年骨科PFNA手术中的比较研究

目的 探讨超声引导下腰丛坐骨神经阻滞在老年骨科PFNA手术中的效果.方法 选择老年骨科PFNA手术患者38例,根据麻醉方式分为A组（采用超声引导下腰丛坐骨神经阻滞）20例,B组（采用腰硬联合麻醉）18例.比较两组术前、阻滞后5min、10min、20min、30min、术毕时的收缩压（SBP）、舒张压（DBP）、心率（HR）变化情况及起效和维持时间.结果 A组SBP、DBP、HR术前、阻滞后各时间点无明显变化（P＞0.05）;B组在阻滞后5min开始SBP、DBP明显降低（P＜0.05）,HR在各时间点无明显变化（P＞0.05）;两组患者术前SBP、DBP、HR无明显差异（P＞0.05）;但B组SBP、DBP在阻滞后5min、10 min、20min、30min、术毕min明显低于A组（P＜0.05）.A组起效时间晚于B组,维持时间长于B组（P＜0.05）.A组不良反应少于B组（P＜0.05）.结论 超声引导下腰丛神经阻滞能提供较准确的穿刺位置,对患者机体血流动力学影响小,麻醉效果确切,术后不良反应少,对老年骨科PFNA术患者尤为适用.

Comparative study of treating elderly orthopedics disease with PFNA operation between ultrasound guided lumbar plexus sciatic nerve block and epidural anesthesia

Objective To investigate the effect of treating elderly orthopedics disease with PFNA operation between ultrasound guided lumbar plexus sciatic nerve block and epidural anesthesia. Methods All 38 elderly patients with orthopedics disease who were treated with PFNA operation were selected, according to anesthesia mode,they were divided into group A and group B,group A in which there were 20 cases were carried out ultrasound guided lumbar plexus sciatic nerve block, group B in which there were 18 cases were carried out epidural anesthesia. The systolic pressure （SBP）, diastolic pressure （DBP）, heart rate （HR） changes before operation, at 5, 10, 20, 30 minutes after anesthesia block, after operation and the onset time,duration time in two groups were compared. Results The SBP, DBP, HR were no significant changes before operation and at every time point after anesthesia in group A （P〉0.05）;the DBP, SBP decreased significantly at 5 minutes after anesthesia in group B （P〈0.05）, the HR at every time point were no significant changes （P〉0.05）;the SBP,DBP, HR in two groups before operation were no significantly different （P 〉 0.05）; but the SBP, DBP at 5,10,20, 30 minutes after operation in group B were significantly lower than those in group A （P〈0.05）. The onset time in group A was later than that of group B ,the duration time was longer than that in group B（P 〈 0.05）.The adverse effects of group A were less than those in group B （P 〈 0.05）. Conclusion Ultrasound guided lumbar plexus nerve block can provide more accurate puncture position, it has little influence on patients hemodynamics, anesthesia effect is good, postoperative adverse reaction is low, it is especially suitable to elderly orthopedics patient who is treated with PFNA operation.