[1]刘宏飞,霍鹏伟△.超声引导下腰丛-坐骨神经阻滞与硬膜外麻醉用于老年膝关节置换术对比研究*[J].陕西医学杂志,2020,49(8):947-950.[doi:DOI:10.3969/j.issn.1000-7377.2020.08.009]
　LIU Hongfei,HUO Pengwei..Comparative study of ultrasound-guided lumbar plexus-sciatic nerve block and epidural anesthesia for knee replacement in elderly[J].,2020,49(8):947-950.[doi:DOI:10.3969/j.issn.1000-7377.2020.08.009]
点击复制

超声引导下腰丛-坐骨神经阻滞与硬膜外麻醉用于老年膝关节置换术对比研究*
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
49
期数:
2020年8期
页码:
947-950
栏目:
临床研究
出版日期:
2020-08-05

文章信息/Info

Title:
Comparative study of ultrasound-guided lumbar plexus-sciatic nerve block and epidural anesthesia for knee replacement in elderly
作者:
刘宏飞; 霍鹏伟△
陕西省榆林市第二医院麻醉科(榆林 719000)
Author(s):
LIU Hongfei; HUO Pengwei.
Department of Anesthesiology,the Second Hospital of Yulin City,Shaanxi Province(Yulin 719000)
关键词:
超声;  腰丛-坐骨神经阻滞;  硬膜外麻醉;  膝关节置换术;  镇静;  血流动力学
Keywords:
Ultrasound;  Lumbar plexus-sciatic nerve block;  Epidural anesthesia;  Knee replacement;  Sedation;  Hemodynamics
分类号:
R614.4
DOI:
DOI:10.3969/j.issn.1000-7377.2020.08.009
文献标志码:
A
摘要:
目的:比较超声引导下腰丛-坐骨神经阻滞及硬膜外麻醉用于老年膝关节置换术的临床效果。方法:行膝关节置换术治疗的患者94例,采用简单抽样法将其分为观察组及对照组,各47例。对照组给予硬膜外麻醉,观察组给予超声引导下腰丛-坐骨神经阻滞。比较两组麻醉优良率; 比较两组患者麻醉前及麻醉后6、12、24 h的Ramsay镇静评分(RSS); 比较两组患者麻醉前、阻滞后10 min、阻滞后30 min、阻滞后60 min的血流动力学指标[心率(HR)、收缩压(SBP)、舒张压(DBP)]; 比较两组手术时间、术中出血量、术中液体量、术后首次进食时间、首次下床时间; 统计患者术后5 d嗜睡、头晕等不良反应总发生情况。结果:观察组麻醉优良率高于对照组,术中出血量、术中液体量少于对照组,术后首次进食时间短于对照组(P<0.05); 观察组麻醉后6、12 h的RSS评分均低于对照组(P<0.05); 观察组阻滞后10、30 min的HR大于对照组,SBP、DBP高于对照组(P<0.05); 观察组不良反应总发生率低于对照组(P<0.05)。结论:在超声引导下,应用腰丛-坐骨神经阻滞对老年膝关节置换术患者进行麻醉,可提高麻醉及镇静效果,改善血流动力学,减少术后不良反应。
Abstract:
Objective:To compare the clinical curative effect of ultrasound-guided lumbar plexus-sciatic nerve block and epidural anesthesia for knee replacement in elderly.Methods:94 patients were divided into observation group and control group by simple sampling method,with 47 cases in each group.The control group was given epidural anesthesia,while the observation group was given ultrasound-guided lumbar plexus-sciatic nerve block.The excellent and good rate of anesthesia,scores of Ramsay sedation scale(RSS)before anesthesia and at 6,12 and 24 hours after anesthesia,hemodynamic indexes [heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)] before anesthesia,at 10,30 and 60 minutes after block,operation time,intraoperative blood loss,intraoperative fluid volume,postoperative first eating time and first leaving bed time were compared between the two groups.The total incidence of drowsiness,dizziness and other adverse reactions at 5 days after surgery was statistically analyzed.Results:The excellent and good rate of anesthesia in the observation group was higher than that in the control group,intraoperative blood loss and intraoperative fluid volume were less than those in the control group,and postoperative first eating time was shorter than that in the control group(P<0.05).At 6 and 12 hours after anesthesia,RSS scores in the observation group were lower than those in the control group(P<0.05).At 10 and 30 minutes after block,HR in the observation group was greater than that in the control group,SBP and DBP were higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion:The application of ultrasound-guided lumbar plexus-sciatic nerve block for knee replacement in elderly patients can improve anesthesia and sedation effect,improve hemodynamics,and reduce postoperative adverse reactions.

参考文献/References:

[1] 王勇刚,尚荣安.肿痛消方治疗全膝关节置换术后肿痛的疗效观察[J].陕西中医,2016,37(5):543-544.
[2] Memtsoudis SG,Yoo D,Stundner O,et al.Subsartorial adductor canal vs femoral nerve block for analgesia after total knee replacement[J].International Orthopaedics,2015,39(4):673-680.
[3] 张海亮,郝静静,路喻清,等.轻比重腰麻与腰丛-坐骨神经阻滞在高龄患者髋部手术中的应用[J].陕西医学杂志,2019,48(9):1134-1137.
[4] 杨伯炜,王树德,王 君,等.连续腰丛联合后路坐骨神经阻滞在老年患者下肢手术中的应用[J].陕西医学杂志,2017,46(6):748-750.
[5] 陈安民,李 锋.骨科疾病诊疗指南[M].北京:科学出版社,2013:12-15.
[6] 邓小明,姚尚龙,于布为.现代麻醉学[M].北京:人民卫生出版社,2014:19-20.
[7] 黄文锋,陈 杰,包晓航,等.腰丛-坐骨神经阻滞与腰麻在老年患者膝关节置换围术期的对比分析[J].局解手术学杂志,2016,25(9):636-640.
[8] 高 翔,夏晓琼,王 亮,等.三种常见麻醉方式对全髋关节置换术的老年患者术后转归的影响[J].临床麻醉学杂志,2018,34(7):669-672.
[9] Stundner O,Meissnitzer M,Brummett CM,et al.Comparison of tissue distribution,phrenic nerve involvement,and epidural spread in standard-vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging:a randomized,controlled trial[J].British Journal of Anaesthesia,2016,116(3):405-412.
[10] 刘湘钰,黄穗葵,邓瑞华.B超引导下腰丛复合坐骨神经阻滞麻醉对老年股骨粗隆间骨折患者麻醉效果与免疫功能的影响[J].中国医师杂志,2018,20(11):1689.
[11] Sarridou DG,Chalmouki G,Braoudaki M,et al.Intravenous parecoxib and continuous femoral block for postoperative analgesia after total knee arthroplasty.a randomized,double-blind,prospective trial[J].Pain Physician,2015,18(3):267-276.
[12] Bareka M,Hantes M,Arnaoutoglou E,et al.Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery[J].Knee Surgery Sports Traumatology Arthroscopy,2017,26(2):478-484.
[13] Lu R,Shen C,Yang C,et al.Comparison of lumbar plexus block using the short?axis in-plane method at the plane of the transverse process and at the articular process:a randomized controlled trial[J].Bmc Anesthesiology,2018,18(1):17-19.
[14] 孔宪刚,李成文,侯代亮.超声引导下股神经联合侧入路腘窝坐骨神经阻滞用于膝关节镜手术麻醉效果观察[J].山东医药,2015,55(48):55-57.
[15] Nabin KC,Rupak KC,Cheng-Shu C,et al.The spatial relationship and surface projection of canine sciatic nerve and sacrotuberous ligament:a perineal hernia repair perspective[J].Plos One,2016,11(3):152078.
[16] 胡敬锋,朱剑斌,姜闽英.神经刺激仪引导的腰丛及坐骨神经阻滞在老年下肢手术的应用[J].广东医学,2016,37(12):1850-1852.
[17] Wood P,Gill M,Edwards D,et al.Clinical and microbiological evaluation of epidural and regional anaesthesia catheters in injured UK military personnel[J].Journal of the Royal Army Medical Corps,2016,162(4):261-265.
[18] 刘湘钰,黄穗葵,邓瑞华.B超引导下腰丛复合坐骨神经阻滞麻醉对老年股骨粗隆间骨折患者麻醉效果与免疫功能的影响[J].中国医师杂志,2018,20(11):97-100.
[19] Tai TW,Su FC,Chien JT,et al.Changes in excursion and strain in the rat sciatic nerve under cauda equina compression induced by epidural balloon inflation[J].Spine Journal,2015,15(2):329-335.

相似文献/References:

[1]李晓滨,王 冰△.超声引导下神经阻滞在腹腔镜胆囊切除术中的临床应用研究[J].陕西医学杂志,2020,49(1):27.
[2]刘 青,景赟杭,冯旭霞,等.超声联合MRI检查对胎盘植入诊断的应用价值分析[J].陕西医学杂志,2020,49(12):1627.[doi:DOI:10.3969/j.issn.1000-7377.2020.12.023]

备注/Memo

备注/Memo:
*陕西省卫生科研基金资助项目(2018F84)
更新日期/Last Update: 2020-08-04