解放军医学院学报
解放軍醫學院學報
해방군의학원학보
Academic Journal of Chinese Pla Medical School
2013年
10期
1022-1024,1080
,共4页
下肢神经阻滞%全身麻醉%膝关节置换术%腰丛,坐骨神经
下肢神經阻滯%全身痳醉%膝關節置換術%腰叢,坐骨神經
하지신경조체%전신마취%슬관절치환술%요총,좌골신경
lower extremity never block%general anesthesia%total knee arthroplasty%lumbar plexus,sciatic nerve
目的：探讨外周神经(腰丛-坐骨神经)阻滞在老年单膝关节置换术中的可行性和安全性。方法选择本院2011年6月-2012年6月择期行单侧膝关节置换术老年患者80例，随机分为全身麻醉(general anesthesia，GA)组(n=40)，外周神经阻滞(nerve block，NB)组(n=40)。分别记录两组入室诱导前(T0)、气管插管即刻或神经阻滞成功后(T1)、切皮(T2)、剥离截骨(T3)、止血带60 min(T4)、松止血带5 min(T5)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)，患者感觉、运动神经阻滞的起效时间，阻滞完善时间及维持时间。并记录与麻醉相关的不良反应。结果 NB组感觉阻滞起效时间为(10.3±4.6) min，维持时间(610±145) min；运动阻滞起效时间为(13.1±4.8) min维持时间为(322±90) min。SBP和DBP在T3期GA组低于NB组(P＜0.05)，在T5期，GA组高于NB组(P＜0.05)。GA组在T4、T5期，SBP、DBP均高于T0(P＜0.05)。NB组的HR在T2期低于T0(P＜0.05)。NB组有2例在截骨时有体动反应，复合静脉用药可完成手术。NB组术后恶心、呕吐发生率低于GA组。两组均无麻醉相关并发症。结论下肢神经阻滞用于老年患者单膝关节置换术安全有效，尤其适用于术后接受抗凝治疗以及不适合全身麻醉的老年患者。
目的：探討外週神經(腰叢-坐骨神經)阻滯在老年單膝關節置換術中的可行性和安全性。方法選擇本院2011年6月-2012年6月擇期行單側膝關節置換術老年患者80例，隨機分為全身痳醉(general anesthesia，GA)組(n=40)，外週神經阻滯(nerve block，NB)組(n=40)。分彆記錄兩組入室誘導前(T0)、氣管插管即刻或神經阻滯成功後(T1)、切皮(T2)、剝離截骨(T3)、止血帶60 min(T4)、鬆止血帶5 min(T5)的收縮壓(SBP)、舒張壓(DBP)、心率(HR)、血氧飽和度(SpO2)，患者感覺、運動神經阻滯的起效時間，阻滯完善時間及維持時間。併記錄與痳醉相關的不良反應。結果 NB組感覺阻滯起效時間為(10.3±4.6) min，維持時間(610±145) min；運動阻滯起效時間為(13.1±4.8) min維持時間為(322±90) min。SBP和DBP在T3期GA組低于NB組(P＜0.05)，在T5期，GA組高于NB組(P＜0.05)。GA組在T4、T5期，SBP、DBP均高于T0(P＜0.05)。NB組的HR在T2期低于T0(P＜0.05)。NB組有2例在截骨時有體動反應，複閤靜脈用藥可完成手術。NB組術後噁心、嘔吐髮生率低于GA組。兩組均無痳醉相關併髮癥。結論下肢神經阻滯用于老年患者單膝關節置換術安全有效，尤其適用于術後接受抗凝治療以及不適閤全身痳醉的老年患者。
목적：탐토외주신경(요총-좌골신경)조체재노년단슬관절치환술중적가행성화안전성。방법선택본원2011년6월-2012년6월택기행단측슬관절치환술노년환자80례，수궤분위전신마취(general anesthesia，GA)조(n=40)，외주신경조체(nerve block，NB)조(n=40)。분별기록량조입실유도전(T0)、기관삽관즉각혹신경조체성공후(T1)、절피(T2)、박리절골(T3)、지혈대60 min(T4)、송지혈대5 min(T5)적수축압(SBP)、서장압(DBP)、심솔(HR)、혈양포화도(SpO2)，환자감각、운동신경조체적기효시간，조체완선시간급유지시간。병기록여마취상관적불량반응。결과 NB조감각조체기효시간위(10.3±4.6) min，유지시간(610±145) min；운동조체기효시간위(13.1±4.8) min유지시간위(322±90) min。SBP화DBP재T3기GA조저우NB조(P＜0.05)，재T5기，GA조고우NB조(P＜0.05)。GA조재T4、T5기，SBP、DBP균고우T0(P＜0.05)。NB조적HR재T2기저우T0(P＜0.05)。NB조유2례재절골시유체동반응，복합정맥용약가완성수술。NB조술후악심、구토발생솔저우GA조。량조균무마취상관병발증。결론하지신경조체용우노년환자단슬관절치환술안전유효，우기괄용우술후접수항응치료이급불괄합전신마취적노년환자。
Objective To study the feasibility and safety of peripheral nerve (lumbar plexus-sciatic nerve) block in total knee replacement for elderly patients. Methods Eighty patients who underwent unilateral knee replacement in our hospital from June 2011 to June 2012 were randomly divided into general anesthesia (GA) group and peripheral nerve block (NB) group (40 in each group). The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), SpO2, and the beginning, peak and maintenance time of sensory and motor nerve block were recorded in two groups before anesthesia (T0), immediately after tracheal intubation (T1), skin cut (T2), decollement and osteostomy (T3), 60 min after use of tourniquet (T4), 5 min after removal of tourniquet (T5). Anesthesia-related adverse reactions were detected in two groups. Results Onset of sensory and motor block was 10.3±4.6 min and 13.1±4.8 min. The maintenance of sensory and motor block was 610±145 min and 322±90 min, P < 0.05. The SBP and DBP were lower in GA group than in peripheral NB group at T3 and higher in GA group than in peripheral NB group at T4 and T5 (P<0.05). The HR was lower in peripheral NB group at T2 than at T0 (P<0.05). Motor reactions were observed in 2 patients of peripheral NB group at osteostomy. The incidence of nausea and vomiting was lower in peripheral NB group than in GA group after operation. No anesthesia-related adverse reaction occurred in two groups. Conclusion Lower extremity never block is safe and effective in unilateral knee replacement for elderly patients, especially for those receiving anticoagulant therapy and those not fit for general anesthesia.
