国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
8期
701-703,712
,共4页
股神经%坐骨神经%神经阻滞麻醉%老年患者%单侧下肢手术
股神經%坐骨神經%神經阻滯痳醉%老年患者%單側下肢手術
고신경%좌골신경%신경조체마취%노년환자%단측하지수술
Femoral nerve%Sciatic nerve%Nerve block anesthesia%Elderly patients%Unilateral lower limb surgery
目的 观察股神经联合坐骨神经阻滞麻醉用于老年患者单侧下肢手术的麻醉效果. 方法 60例行下肢手术的老年患者,年龄60岁～80岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,按随机数字表法分为A、B两组,每组30例.A组采用外周神经刺激仪定位,分别于股神经、坐骨神经处注入0.5％罗哌卡因30 ml;B组于L2～3或L3～4.间隙穿刺,向蛛网膜下腔注入0.5％罗哌卡因2 ml,硬膜外向头端置管4 cm.观察并记录两组患者麻醉前(T0)和麻醉后15(T1)、30(T2)、45(T3)、60 min(T4)时的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean artery pressure,MAP)、心率(heartrate,HR)和口脉搏血氧饱和度(pulse oxygen saturation,SpO2),记录两组的麻醉效果和副作用发生情况. 结果 麻醉前两组患者的SBP、DBP、MAP、HR和SpO2的比较差异均无统计学意义(P＞0.05);与T0比较,A组T1时的MAP无明显变化(P＞0.05),而B组T1时的MAP从(96±8) mmHg(1 mmHg=0.133 kPa)降至(84±6) mmHg(P＜0.01);同一时刻比较,B组T1时的MAP为(84±6) mmHg,明显低于A组(98±7) mmHg(P＜0.01),两组麻醉前后HR和SpO2无明显变化(P＞0.05);两组的麻醉效果均满意,差异无统计学意义(P＞0.05);B组有12例尿潴留,5例恶心、呕吐,2例心动过缓,而A组只有1例患者发生心动过缓,两组差异有统计学意义(P＜0.05). 结论 股神经联合坐骨神经阻滞用于老年患者单侧下肢手术麻醉效果确切,血流动力学比较稳定,副作用少.
目的 觀察股神經聯閤坐骨神經阻滯痳醉用于老年患者單側下肢手術的痳醉效果. 方法 60例行下肢手術的老年患者,年齡60歲～80歲,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅲ級,按隨機數字錶法分為A、B兩組,每組30例.A組採用外週神經刺激儀定位,分彆于股神經、坐骨神經處註入0.5％囉哌卡因30 ml;B組于L2～3或L3～4.間隙穿刺,嚮蛛網膜下腔註入0.5％囉哌卡因2 ml,硬膜外嚮頭耑置管4 cm.觀察併記錄兩組患者痳醉前(T0)和痳醉後15(T1)、30(T2)、45(T3)、60 min(T4)時的收縮壓(systolic blood pressure,SBP)、舒張壓(diastolic blood pressure,DBP)、平均動脈壓(mean artery pressure,MAP)、心率(heartrate,HR)和口脈搏血氧飽和度(pulse oxygen saturation,SpO2),記錄兩組的痳醉效果和副作用髮生情況. 結果 痳醉前兩組患者的SBP、DBP、MAP、HR和SpO2的比較差異均無統計學意義(P＞0.05);與T0比較,A組T1時的MAP無明顯變化(P＞0.05),而B組T1時的MAP從(96±8) mmHg(1 mmHg=0.133 kPa)降至(84±6) mmHg(P＜0.01);同一時刻比較,B組T1時的MAP為(84±6) mmHg,明顯低于A組(98±7) mmHg(P＜0.01),兩組痳醉前後HR和SpO2無明顯變化(P＞0.05);兩組的痳醉效果均滿意,差異無統計學意義(P＞0.05);B組有12例尿潴留,5例噁心、嘔吐,2例心動過緩,而A組隻有1例患者髮生心動過緩,兩組差異有統計學意義(P＜0.05). 結論 股神經聯閤坐骨神經阻滯用于老年患者單側下肢手術痳醉效果確切,血流動力學比較穩定,副作用少.
목적 관찰고신경연합좌골신경조체마취용우노년환자단측하지수술적마취효과. 방법 60례행하지수술적노년환자,년령60세～80세,미국마취의사협회(ASA)분급Ⅰ～Ⅲ급,안수궤수자표법분위A、B량조,매조30례.A조채용외주신경자격의정위,분별우고신경、좌골신경처주입0.5％라고잡인30 ml;B조우L2～3혹L3～4.간극천자,향주망막하강주입0.5％라고잡인2 ml,경막외향두단치관4 cm.관찰병기록량조환자마취전(T0)화마취후15(T1)、30(T2)、45(T3)、60 min(T4)시적수축압(systolic blood pressure,SBP)、서장압(diastolic blood pressure,DBP)、평균동맥압(mean artery pressure,MAP)、심솔(heartrate,HR)화구맥박혈양포화도(pulse oxygen saturation,SpO2),기록량조적마취효과화부작용발생정황. 결과 마취전량조환자적SBP、DBP、MAP、HR화SpO2적비교차이균무통계학의의(P＞0.05);여T0비교,A조T1시적MAP무명현변화(P＞0.05),이B조T1시적MAP종(96±8) mmHg(1 mmHg=0.133 kPa)강지(84±6) mmHg(P＜0.01);동일시각비교,B조T1시적MAP위(84±6) mmHg,명현저우A조(98±7) mmHg(P＜0.01),량조마취전후HR화SpO2무명현변화(P＞0.05);량조적마취효과균만의,차이무통계학의의(P＞0.05);B조유12례뇨저류,5례악심、구토,2례심동과완,이A조지유1례환자발생심동과완,량조차이유통계학의의(P＜0.05). 결론 고신경연합좌골신경조체용우노년환자단측하지수술마취효과학절,혈류동역학비교은정,부작용소.
Objective To observe the efficacy of femoral and sciatic nerve block in unilateral lower limb surgery in elderly patients.Methods Sixty ASA Ⅰ-Ⅲ patients aged 60 to 80 years,undergoing unilateral lower limb surgery were randomly divided into two groups (n=30).In group A,the femoral and sciatic nerve was identified and blocked with 30 ml of 0.5％ ropivacaine respectively guided with peripheral nerve stimulator.In group B,subarachnoid anesthesia was performed with 2 ml of 0.5％ ropivacaine injected at spinal interspaces L2-3 or L3-4 before an epidural catheter was inserted for anesthesia maintenance.Blood pressure,heart rate and pulse oxygen saturation were monitored before anesthesia (T0) and 15 (T1),30 (T2),45 (Ta),60 min(T4) after anesthesia.The effectiveness of anesthesia and the incidence of adverse reactions were observed in both groups.Results There was no significant difference between the two groups in mean artery pressure (MAP) before anesthesia,while in group B,the MAP were decreased from (96±8) mmHg(1 mmHg=0.133 kPa) to (84±6) mmHg(P＜0.01) at 15 min after anesthesia compaired to preanesthesia.The MAP in group A were(98±7) mmHg while(84±6) mmHg in group B(P＜0.01) at 15 min after anesthesia and that at 30,45 min after induction was also decreased (P＜0.05).There was no significant difference in the analgesia effects between the two groups.The incidence of adverse events (urinary retention,nausea and vomiting,etc.) was higher in group B (P＜0.05).Conclusions Femoral and sciatic nerve block is a safe and efficient technique with more stable hemodynamic status and less adverse events in elderly patients undergoing unilateral lower limb surgery.
