危重患者下肢手术中采用B超引导下定位腰丛-坐骨神经阻滞麻醉的效果
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摘要
目的探讨危重患者下肢手术中采用B超引导下定位腰丛-坐骨神经阻滞麻醉的效果。方法选择80例危重下肢手术患者作为研究对象,患者均实施腰丛-坐骨神经阻滞麻醉,按随机数表法将其分为常规组(n=40,常规麻醉操作)和超声组(n=40,B超引导下定位)。比较两组患者的生命体征、皮质醇水平、镇静评分、麻醉起效时间、维持时间及麻醉安全性。结果麻醉前、麻醉后10、30 min,两组患者心率、平均动脉压、皮质醇水平、Ramsay评分及不良反应总发生率无显著差异(P>0.05)。两组患者麻醉后10、30 min的Ramsay评分均明显高于麻醉前(P<0.05)。超声组感觉神经阻滞、运动神经阻滞起效时间、维持时间及神经损伤并发症总发生率明显优于常规组(P<0.05)。结论危重患者下肢手术中实施B超引导下定位腰丛-坐骨神经阻滞麻醉起效快,麻醉维持时间更长,且可减少神经损伤,术中对生命体征及应激指标无影响,麻醉安全性高。
Objective To investigate the effect of B-ultrasound-guided locating lumbar plexus-sciatic nerve block anesthesia in critically ill patients with lower extremity surgery. Methods Eighty patients with critical lower extremity surgery were selected as the reaserch objects. All patients underwent lumbar plexus-sciatic nerve block anesthesia.According to the random number table, they were divided into conventional group(n=40, routine anesthesia operation) and ultrasound group(n=40, B-ultrasound-guided locating). The vital signs, cortisol levels, sedative effect, onset and duration of anesthesia and safety of anesthesia were compared between the two groups. Results Compared with pre-anesthesia, 10 minutes after anesthesia, there were no significant differences in heart rates, mean arterial pressure, cortisol levels, Ramsay scores and total incidences of adverse reactions between the two groups(P>0.05). The Ramsay scores of 10 and 30 minutes after anesthesia in both groups were significantly higher than those before anesthesia(P<0.05). The onset time and duration time of sensory nerve block and motor nerve block and the total incidence of nerve injury complications in the ultrasound group were significantly better than those in the conventional group(P<0.05). Conclusion In the lower extremity surgery of critically ill patients, the B-ultrasound-guided lumbar plexus-sciatic nerve block anesthesia has a rapid onset, longer anesthesia duration time, and can alleviate the nerve damage and has no effect on intraoperative vital signs and stress indicators. It has high safety of anesthesia.
Objective To investigate the effect of B-ultrasound-guided locating lumbar plexus-sciatic nerve block anesthesia in critically ill patients with lower extremity surgery. Methods Eighty patients with critical lower extremity surgery were selected as the reaserch objects. All patients underwent lumbar plexus-sciatic nerve block anesthesia.According to the random number table, they were divided into conventional group(n=40, routine anesthesia operation) and ultrasound group(n=40, B-ultrasound-guided locating). The vital signs, cortisol levels, sedative effect, onset and duration of anesthesia and safety of anesthesia were compared between the two groups. Results Compared with pre-anesthesia, 10 minutes after anesthesia, there were no significant differences in heart rates, mean arterial pressure, cortisol levels, Ramsay scores and total incidences of adverse reactions between the two groups(P>0.05). The Ramsay scores of 10 and 30 minutes after anesthesia in both groups were significantly higher than those before anesthesia(P<0.05). The onset time and duration time of sensory nerve block and motor nerve block and the total incidence of nerve injury complications in the ultrasound group were significantly better than those in the conventional group(P<0.05). Conclusion In the lower extremity surgery of critically ill patients, the B-ultrasound-guided lumbar plexus-sciatic nerve block anesthesia has a rapid onset, longer anesthesia duration time, and can alleviate the nerve damage and has no effect on intraoperative vital signs and stress indicators. It has high safety of anesthesia.
引文
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[9]杨少平.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手术中的效果比较[J].中国实用神经疾病杂志,2015,18(10):87-88.
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[12]黄志胜,陈志成,王宁,等.联合引导腰丛-坐骨神经阻滞的临床应用[J].中国现代医学杂志,2018,29(3):113-118.
[2]音樱,谢言虎,章敏,等.超声联合神经刺激器引导下腰丛-腘窝坐骨神经阻滞在大隐静脉曲张手术中的应用效果[J].安徽医学,2017,38(2):154-158.
[3]丁利刚,顾学鹏,姜山,等.超声联合神经刺激仪定位腰丛-坐骨神经阻滞应用比较[J].中国疼痛医学杂志,2016,22(12):944-946.
[4]杨显洲.超声引导下腰丛联合坐骨神经阻滞麻醉在老年患者下肢骨科手术中的应用效果[J].临床合理用药杂志,2017,10(18):131-132.
[5]刘冲,王志学,董龙,等.静脉辅助右美托咪定复合瑞芬太尼在腰丛-坐骨神经阻滞下老年髋关节置换术中对镇痛与应激的影响[J].中国老年学杂志,2017,37(5):1195-1198.
[6]董娇娇,赵施施,林胜仙,等.年龄因素对患者腰丛联合坐骨神经阻滞时罗哌卡因药代动力学的影响[J].中华麻醉学杂志,2016,36(7):839-842.
[7]朱爱军,蔡秋瑾,许培红,等.超声联合神经刺激仪引导神经阻滞在老年高危患者全髋关节置换术中的应用[J].中国现代医生,2016,54(33):119-123.
[8]刘冲,王志学,董龙,等.静脉辅助右美托咪定复合瑞芬太尼对腰丛-坐骨神经阻滞老年髋关节置换患者术中循环呼吸与镇静的影响[J].中国老年学杂志,2016,36(23):5928-5931.
[9]杨少平.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手术中的效果比较[J].中国实用神经疾病杂志,2015,18(10):87-88.
[10]高敬,王春霞.超声联合神经刺激仪定位腰丛-坐骨神经阻滞用于危重患者下肢手术的麻醉效果分析[J].中国实用医药,2016,11(30):212-213.
[11]孟丹,朱玉成.危重患者下肢手术中超声联合神经刺激仪定位腰丛-坐骨神经阻滞的临床应用价值分析[J].航空航天医学杂志,2016,27(4):462-463.
[12]黄志胜,陈志成,王宁,等.联合引导腰丛-坐骨神经阻滞的临床应用[J].中国现代医学杂志,2018,29(3):113-118.