超声引导坐骨神经和股神经阻滞在老年患者膝部以下手术中的应用
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摘要
目的观察超声引导下坐骨神经和股神经阻滞在老年患者膝部以下手术的麻醉效果。方法 150例择期膝部以下手术的老年患者,随机分为超声引导坐骨神经和股神经阻滞组(A组)和硬膜外阻滞组(B组),每组75例。记录两组麻醉前5 min及麻醉后5、10、20、30、60 min的心率、收缩压、舒张压、脉搏血氧饱和度及感觉阻滞起效时间、感觉阻滞及运动阻滞维持时间、感觉阻滞及运动阻滞的阻滞程度、麻醉效果等。结果观察期两组的心率、脉搏血氧饱和度比较差异无统计学意义(P>0.05)。麻醉前两组收缩压、舒张压比较差异无统计学意义;B组麻醉后20、30 min的收缩压、舒张压低于麻醉前5 min,差异有统计学意义(P<0.05)。B组麻醉后20、30 min的收缩压及麻醉后20、30、60 min舒张压与A组比较差异有统计学意义(P<0.05)。A组神经阻滞起效时间短于B组,差异有统计学意义(P<0.05),A组感觉阻滞、运动阻滞维持时间长于B组,差异有统计学意义(P<0.05)。A组胫神经感觉阻滞效果优于B组,差异有统计学意义(P<0.05),两组运动阻滞效果差异无统计学意义(P>0.05)。A组麻醉效果优与B组,差异有统计学意义(P<0.05)。结论与硬膜外阻滞相比,超声引导下坐骨神经和股神经阻滞在老年患者膝部以下手术血流动力学更稳定,阻滞起效快,感觉阻滞效果、麻醉效果更优,感觉阻滞、运动阻滞维持时间更长。
Objective To observe the anesthetic effect of ultrasound-guided sciatic nerve and femoral nerve block in the below the knee surgery of elderly patients. Methods A total of 150 elderly patients undergoing elective below the knee surgery were randomly divided into ultrasound-guided sciatic nerve and femoral nerve block group(group A) and epidural block group(group B), with 75 cases in each group. The heart rate, systolic blood pressure, diastolic blood pressure, pulse oximetry and sensory block onset time, sensory block and exercise block maintenance time, the degree of blockade of sensory block and motor block, anesthesia effect of two groups were recorded at 5 minutes before anesthesia and 5, 10, 20, 30, 60 minutes after anesthesia. Results There was no significant difference in heart rate and pulse oximetry between the two groups during the observation period(P>0.05). There was no significant difference in systolic and diastolic blood pressure between the two groups before anesthesia. The systolic blood pressure and diastolic blood pressure at 20 and 30 min after anesthesia in group B were lower than those at 5 min before anesthesia, and the difference was significant(P<0.05). The systolic blood pressure in group B at 20 and 30 minutes after anesthesia and the diastolic blood pressure at 20, 30, and 60 minutes after anesthesia were significantly different from that in group A(P<0.05). The onset time of group A nerve block was shorter than that of group B(P<0.05). The maintenance time of sensory block and motor block in group A was longer than that in group B(P<0.05). The sensory block effect of sacral nerve in group A was better than that in group B, and the difference was significant(P<0.05). There was no significant difference in the exercise block effect in two groups(P>0.05).The anesthetic effect of group A was significantly different from that of group B(P<0.05). Conclusion Compared with epidural block, ultrasound-guided sciatic nerve and femoral nerve block has more stable hemodynamics, fast block onset, better sensory block effect and anesthesia effect, longer maintenance time of sensory block and exercise block in surgery of below the knee in elderly patients.
Objective To observe the anesthetic effect of ultrasound-guided sciatic nerve and femoral nerve block in the below the knee surgery of elderly patients. Methods A total of 150 elderly patients undergoing elective below the knee surgery were randomly divided into ultrasound-guided sciatic nerve and femoral nerve block group(group A) and epidural block group(group B), with 75 cases in each group. The heart rate, systolic blood pressure, diastolic blood pressure, pulse oximetry and sensory block onset time, sensory block and exercise block maintenance time, the degree of blockade of sensory block and motor block, anesthesia effect of two groups were recorded at 5 minutes before anesthesia and 5, 10, 20, 30, 60 minutes after anesthesia. Results There was no significant difference in heart rate and pulse oximetry between the two groups during the observation period(P>0.05). There was no significant difference in systolic and diastolic blood pressure between the two groups before anesthesia. The systolic blood pressure and diastolic blood pressure at 20 and 30 min after anesthesia in group B were lower than those at 5 min before anesthesia, and the difference was significant(P<0.05). The systolic blood pressure in group B at 20 and 30 minutes after anesthesia and the diastolic blood pressure at 20, 30, and 60 minutes after anesthesia were significantly different from that in group A(P<0.05). The onset time of group A nerve block was shorter than that of group B(P<0.05). The maintenance time of sensory block and motor block in group A was longer than that in group B(P<0.05). The sensory block effect of sacral nerve in group A was better than that in group B, and the difference was significant(P<0.05). There was no significant difference in the exercise block effect in two groups(P>0.05).The anesthetic effect of group A was significantly different from that of group B(P<0.05). Conclusion Compared with epidural block, ultrasound-guided sciatic nerve and femoral nerve block has more stable hemodynamics, fast block onset, better sensory block effect and anesthesia effect, longer maintenance time of sensory block and exercise block in surgery of below the knee in elderly patients.
引文
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[13]马琳,杨勇,王国林.外周神经阻滞在80岁以上危重患者单侧下肢手术中的应用[J].中华老年医学杂志,2005,24(2):176-180.
[14]李永庆,肖光文,张岳农.股神经-坐骨神经联合阻滞用于老年患者下肢手术术后谵妄情况的分析[J].吉林医学,2017,38(5):837-840.
[15]Ceylan BG,San AK,Ozorak O,et al.combined fermoral and sciatic nerve block in a cachectic progressive systemic sclerosis case with gastrointestinal and cardiac involvment[J].Aqri,2010,22(4):165-169.
[16]Zhang L,Tong Y,Li M,et al.sciatic-femoral nerve block versus unilateral spinal anaesthesia for outpatient knee arthroscopy:A meta-analysis[J].Minerva,Anestesiol,2015,81(12):1359-1368.
[17]Davarci I,Tuzcu K,Karcioglu M,et al.Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy[J].Int Med Res,2013,41(5):1639-1647.
[18]徐启明,郭曲练,姚尚龙,等.临床麻醉学[M].第2版.北京:人民卫生出版社,2006:125.
[19]王爱忠,陈佳,江伟.超声引导连续坐骨神经阻滞用于足部手术术后镇痛[J].临床麻醉学杂志,2009,25(9)767-769.
[20]Kumaz MM,ErsoyA,Altan A,et al.Comparison of hemodynamics,recovery profile and postoperative analgesia of unilateral spinal anaesthesia with sciatic-femoral nerve block in knee arthroscopy[J].Aqri,2014,26(4):171-178.
[2]McNaught A,Shastri U,Carmichael N,et al.Ultrasound reduces the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block[J].British Journal of Anaesthesia,2011,106(1):124-130.
[3]Renes SH,Van Geffen GJ,Rettiq HC,et al.Mini mum effective volume of local anesthetic for shoulder analgesia by ultrasound-guided block at root C7 with assessment of pulmonary function[J].Reg Anesth Pain Med,2010,35(6):529-534.
[4]倪勇,徐斌,魏长娜,等.超声引导下神经阻滞(五)——坐骨神经及其分支阻滞[J].实用疼痛学杂志,2011,7(5):379-386.
[5]陈云俊,夏艳,胡海青,等.神经刺激仪引导下外周神经阻滞与蛛网膜下腔阻滞用于下肢手术的比较[J].临床麻醉学杂志,2013,29(8):749-751.
[6]Casati A,Danelli G,Baciarello M,et al.A prospective,randomized comparison,between ultrasound and nerve stimulation guidance for multiple injec tion axillary brachial plexus block[J].Anesthesiology,2007,106(5):992-996.
[7]韩彬,赵俊莺,王武涛,等.超声引导股骨近端一针两点技术在老年膝关节以下手术的应用[J].国际麻醉学与复苏杂志,2017,38(9):793-797.
[8]彭裕文.局部解剖学[M].第6版,北京:人民卫生出版社,2004:237-245
[9]Sia S,Bartoli M,Lepri A,et al.Multiple-injection axillary brachial plexus block:A comparison of two method of nerve localization-nerve stimulation versus paresthesia[J].Anesth Analg,2000,91:647.
[10]吴振威,孙建良,黄兵.股神经复合坐骨神经阻滞与蛛网膜下隙阻滞用于踝部手术比较[J].中国医师进修杂志,2013,36(6):45-47.
[11]Hwang J,Min S,Kim C,et al.Prophylactic glycopyrrolate reduces hypotensive responses in elderly patients during spinal anesthesia:a randomized controlled trial[J].Can JAnaesth,2014.61(1):32-38.
[12]Dyamanna DN,Bs SK,Zacharia BT.Unexpected bradycaria and cardiac arrest under spinal anesthesia:ease reports and review of literature[J].Middle East J Anaesthesiol,2013,22(1):121-125.
[13]马琳,杨勇,王国林.外周神经阻滞在80岁以上危重患者单侧下肢手术中的应用[J].中华老年医学杂志,2005,24(2):176-180.
[14]李永庆,肖光文,张岳农.股神经-坐骨神经联合阻滞用于老年患者下肢手术术后谵妄情况的分析[J].吉林医学,2017,38(5):837-840.
[15]Ceylan BG,San AK,Ozorak O,et al.combined fermoral and sciatic nerve block in a cachectic progressive systemic sclerosis case with gastrointestinal and cardiac involvment[J].Aqri,2010,22(4):165-169.
[16]Zhang L,Tong Y,Li M,et al.sciatic-femoral nerve block versus unilateral spinal anaesthesia for outpatient knee arthroscopy:A meta-analysis[J].Minerva,Anestesiol,2015,81(12):1359-1368.
[17]Davarci I,Tuzcu K,Karcioglu M,et al.Comparison between ultrasound-guided sciatic-femoral nerve block and unilateral spinal anaesthesia for outpatient knee arthroscopy[J].Int Med Res,2013,41(5):1639-1647.
[18]徐启明,郭曲练,姚尚龙,等.临床麻醉学[M].第2版.北京:人民卫生出版社,2006:125.
[19]王爱忠,陈佳,江伟.超声引导连续坐骨神经阻滞用于足部手术术后镇痛[J].临床麻醉学杂志,2009,25(9)767-769.
[20]Kumaz MM,ErsoyA,Altan A,et al.Comparison of hemodynamics,recovery profile and postoperative analgesia of unilateral spinal anaesthesia with sciatic-femoral nerve block in knee arthroscopy[J].Aqri,2014,26(4):171-178.