腰丛加坐骨神经与腰丛联合第一骶后孔电针刺阻滞麻醉在老年髋关节置换术中的应用比较

目的]比较选择性腰丛加坐骨神经阻滞麻醉与腰丛联合第一骶后孔电针刺阻滞在老年髋关节置换术中的应用效果.方法]本院行髋关节置换术的老年患者60例,根据麻醉方式不同分为两组,各30例,A组行腰丛加坐骨神经电针刺阻滞;B组行腰丛联合第一骶后孔电针刺阻滞.比较两组手术期血流动力学变化情况、阻滞成功率、麻醉效果和不良反应.结果]A组患者各时间点收缩压(SBP)、舒张压(DBP)和心率(HR)比较差异均无显著性(P>0.05);B组在手术开始后10 min、20 min时患者SBP与阻滞前相比有所下降,且差异有显著性(P<0.05);各时间点HR、DBP比较差异均无显著性(P>0.05).注药后30 min,A组腰骶丛神经支配皮区针刺感觉阻滞成功率为98%~100%,B组为92%~100%.A组麻醉优良率为100%,高于B组93.3%,但两组相比较差异无显著性(P>0.05).两组患者均未发生局麻药中毒.结论]相较于腰丛联合第一骶后孔电针刺阻滞麻醉,选择性腰丛加坐骨神经电针刺阻滞麻醉其患者的HR、SBP和DBP均较为稳定,各水平面阻滞成功率较高,神经麻醉效果较好,为老年髋关节置换术较优选择.

Comparison of the Selective Lumbar Plexus Combined with Sciatic Nerve Block and Lumbar Plexus Combined with the First Posterior Sacral Foramen Block in Hip Replacement for the Elderly

Objective]To compare the application of selective lumbar plexus combined with sciatic nerve block and lumbar plexus combined with the first posterior sacral foramen block in hip replacement for the elderly.Methods]Sixty elderly patients who needed to be treated with hip replacement were divided into Group A (lumbar plexus and sciatic nerve block) and B group (lumbar plexus combined with the first posterior sacral foramen block) according to different anesthesia methods, 30 cases in each group.The hemodynamic changes, the success rate of block, anesthetic effect and adverse reactions in the two groups were recorded.Results] There was no significant difference in HR, SBP and DBP in the Group A at different time points (P>0.05).In the Group B, 10 min ,20 min after the start of operation, the SBP decreased compared with the previous block, and the difference was significant (P<0.05);There were no significant differences in HR and DBP at each time point (P>0.05).30 min after injection, skin needling sensation block success rate in the lumbosacral plexus nerve skin area of the Group A was 98%~100%, and that of the Group B was 92%~100%.The excellent rate of anesthesia in the Group A was 100%, higher than that in the Group B, but there was no significant difference between the two groups (P>0.05) (93.3%).No local anesthetic poisoning occurred in the two groups.Conclusion] Compared with the first posterior sacral foramen block, HR, SBP and DBP of patients receiving lumbar plexus and sciatic nerve block are relatively stable, the success rates of different block levels are higher with better anesthetic effect.It is a better choice for hip replacement.