北京医学
北京醫學
북경의학
BEIJING MEDICAL JOURNAL
2014年
8期
663-665
,共3页
腘窝坐骨神经%隐神经%拇外翻%神经刺激仪
腘窩坐骨神經%隱神經%拇外翻%神經刺激儀
객와좌골신경%은신경%무외번%신경자격의
Popliteal sciatic nerve%Saphenous nerve%Hallex valgus%Nerve stimulator
目的：观察神经刺激仪引导下腘窝坐骨神经并隐神经阻滞用于拇外翻矫正术中穿刺的准确性、并发症情况及麻醉效果，并与硬膜外麻醉进行比较。方法择期拇外翻矫正术48例，年龄18～70岁，ASAⅠ～Ⅲ级，随机分为腘窝坐骨神经并隐神经阻滞组（P组，n=24）和硬膜外阻滞组（E组，n=24）。 P组采用神经刺激仪引导下腘窝坐骨神经并隐神经阻滞，E组采用硬膜外麻醉，选L3～4间隙穿刺，成功后两组均注入1%利多卡因与0.5%罗哌卡因混合液。观察两组血流动力学，感觉、运动阻滞效果，术后镇痛情况，不良反应及舒适满意度。结果 P组血流动力学稳定，感觉和运动阻滞起效时间与E组比较差异无统计学意义[（9±8）min vs.（12±5）min，（14±5）min vs.（16±8）min，P>0.05]；恢复时间长于E组[（562±125）min vs.（346±91）min，（392±85）min vs.（262±95）min，P<0.05]；不良反应少，舒适满意度高于E组。结论神经刺激仪引导下腘窝坐骨神经并隐神经阻滞用于拇外翻手术麻醉效果满意，术中血流动力学稳定，术后镇痛时间长，不良反应轻微，患者满意度高，是拇外翻矫正术较好的麻醉方法。
目的：觀察神經刺激儀引導下腘窩坐骨神經併隱神經阻滯用于拇外翻矯正術中穿刺的準確性、併髮癥情況及痳醉效果，併與硬膜外痳醉進行比較。方法擇期拇外翻矯正術48例，年齡18～70歲，ASAⅠ～Ⅲ級，隨機分為腘窩坐骨神經併隱神經阻滯組（P組，n=24）和硬膜外阻滯組（E組，n=24）。 P組採用神經刺激儀引導下腘窩坐骨神經併隱神經阻滯，E組採用硬膜外痳醉，選L3～4間隙穿刺，成功後兩組均註入1%利多卡因與0.5%囉哌卡因混閤液。觀察兩組血流動力學，感覺、運動阻滯效果，術後鎮痛情況，不良反應及舒適滿意度。結果 P組血流動力學穩定，感覺和運動阻滯起效時間與E組比較差異無統計學意義[（9±8）min vs.（12±5）min，（14±5）min vs.（16±8）min，P>0.05]；恢複時間長于E組[（562±125）min vs.（346±91）min，（392±85）min vs.（262±95）min，P<0.05]；不良反應少，舒適滿意度高于E組。結論神經刺激儀引導下腘窩坐骨神經併隱神經阻滯用于拇外翻手術痳醉效果滿意，術中血流動力學穩定，術後鎮痛時間長，不良反應輕微，患者滿意度高，是拇外翻矯正術較好的痳醉方法。
목적：관찰신경자격의인도하객와좌골신경병은신경조체용우무외번교정술중천자적준학성、병발증정황급마취효과，병여경막외마취진행비교。방법택기무외번교정술48례，년령18～70세，ASAⅠ～Ⅲ급，수궤분위객와좌골신경병은신경조체조（P조，n=24）화경막외조체조（E조，n=24）。 P조채용신경자격의인도하객와좌골신경병은신경조체，E조채용경막외마취，선L3～4간극천자，성공후량조균주입1%리다잡인여0.5%라고잡인혼합액。관찰량조혈류동역학，감각、운동조체효과，술후진통정황，불량반응급서괄만의도。결과 P조혈류동역학은정，감각화운동조체기효시간여E조비교차이무통계학의의[（9±8）min vs.（12±5）min，（14±5）min vs.（16±8）min，P>0.05]；회복시간장우E조[（562±125）min vs.（346±91）min，（392±85）min vs.（262±95）min，P<0.05]；불량반응소，서괄만의도고우E조。결론신경자격의인도하객와좌골신경병은신경조체용우무외번수술마취효과만의，술중혈류동역학은정，술후진통시간장，불량반응경미，환자만의도고，시무외번교정술교호적마취방법。
Objective To observe the accuracy, effect and complications of the nerve stimulator guided popliteal sciatic nerve and saphenous nerve block for hallux valgus. Methods Forty-eight cases who were electively operated for hallux valgus, aged 18~70 years old, ASA I~Ⅲ grade, were randomly divided into the popliteal sciatic nerve and saphe-nous nerve block group (group P, n=24) and epidural anesthesia group (group E, n=24). In group P, popliteal sciatic nerve and saphenous nerve block was guided by a nerve stimulator. In group B, epidural anesthesia was performed at L3~4. Pa-tients of these two groups were injected with 1% lidocaine and 0.5% ropivacaine after being successfully punctured. Sub-squently, the mixed liquid of 1%lidocaine and 0.5%bupivacaine was injected. The two groups were observed for hemody-namics, sensory motor block effects, postoperative analgesia, adverse reactions and comfort of patients. Results Compared with group E, hemodynamics of group P was more stable, while sensory and motor block onset time was not significantly different (P> 0.05), the analgesia maintaining time was significantly longer than that of group E (P< 0.05), at the same time, less adverse reactions were observed, and patients were more comfortable. Conclusion The nerve stimulator guided popliteal sciatic nerve and saphenous nerve block for hallux valgus operation is a good choice with satisfactory block ef-fects, stable hemodynamics, longer time of postoperative analgesia, few complication and more patient satisfaction.
