腰丛-坐骨神经联合阻滞在老年人下肢手术中的应用及对围手术期应激反应的影响

目的:探讨腰丛-坐骨神经联合阻滞和硬膜外麻醉在老年人下肢手术中的应用,比较两者临床麻醉起效和恢复时间、术后镇痛效果、血液动力学的变化及围术期应激反应的影响。方法:48例拟行单侧下肢手术的老年病人,随机分为腰丛-坐骨神经联合阻滞(NER)和硬膜外麻醉(EPI)。记录麻醉前,手术开始后15、30、45、60min,术后1h的收缩压(SBP)、舒张压(DBP)和心率(HR),以及感觉、运动神经阻滞起效及恢复时间、镇痛维持时间、效果及术前、术中、术毕的血浆皮质醇、血糖及胰岛素水平。结果:手术开始后15min,EPI组病人DBP降低明显,随后30、45、60min及术后1hEPI组病人的SBP、DBP均明显低于NER组;NER组感觉、运动神经阻滞起效时间均小于EPI组,恢复时间明显长于EPI组;两组血浆皮质醇、血糖、胰岛素均较术前明显升高,EPI组升高幅度小于NER组。结论:神经刺激器定位下行腰丛-坐骨神经联合阻滞,麻醉效果佳,且有效抑制应激反应。

Effects of combined lumbar plexus sciatic never block in the elderly undergoing lower-extremity surgery

Objective: To compare the effects of combined lumbar plexus-sciatic nerve block with epidural anesthesia in the elderly undergoing lower-extremity surgery. Methods: 48 old patients subject to single lower limb operation were randomly divided into 2 groups: combined lumbar plexus-sciatic nerve block group (group NER) and epidural anesthesia group (group EPI). The SBP、DBP and HR were measured before anesthesia,skin incision,15min,30min,45min, 60min after incision and 1h after operation. The onset time and the recovery time of both motor block and sensory block , the duration and the efficacy of anesthesia were all recorded. The concentration of cortisol,glucose and insulin in plasma was measured before operation,during operation and postoperation. Result: In group EPI, the DBP were distinctly decreased at 15min after incision . The SBP and DBP of 30min,45min,60min and 1h postoperation in group EPI were significantly lower than that in group NER. The onset time of sensory and motor block in group NER were shorter than that of in group EPI . In both groups the concentrations of cortisol,glucose and insulin in plasma were increased during operation and postoperation , compared with those of before operation. The extent of the increasing of plasma cortisol,glucose and insulin in group NER was lower than that of in group EPI . Conclusions: The combined lumbar plexus-sciatic nerve block using the nerve stimulator has a high success rate,little influence on hemodynamics. It takes effect fast and maintain long for analgesia. It can inhibite the stress of operation effectivly. The combined lumbar plexus-sciatic nerve block using the nerve stimulator is an ideal aneshesia method for elderly patients subject to single lower limb operation.