中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
7期
836-838
,共3页
杨光%向芮%王文璨%殷臣竹%张进%张兰
楊光%嚮芮%王文璨%慇臣竹%張進%張蘭
양광%향예%왕문찬%은신죽%장진%장란
坐骨神经%神经传导阻滞%超声检查%经皮神经电刺激
坐骨神經%神經傳導阻滯%超聲檢查%經皮神經電刺激
좌골신경%신경전도조체%초성검사%경피신경전자격
Sciatic nerve%Nerve block%Ultrasonography%Transcutaneous electric nerve stimulation
目的 评价超声联合神经刺激仪引导改良侧入路坐骨神经阻滞术用于足部手术的可行性.方法 择期行足部手术患者62例,性别不限,年龄18 ～ 60岁,BMI＜ 30 kg/m2,ASA分级Ⅰ-Ⅲ级.静脉注射异丙酚2～4 mg/kg和舒芬太尼0.2 ～ 0.4 μg/kg麻醉诱导后置入喉罩并行机械通气,持续吸入七氟醚.在超声联合神经刺激仪引导下于改良侧入路(股骨中上1/3附近)实施坐骨神经阻滞术,注入0.3％罗哌卡因30 ml.坐骨神经阻滞完成后,静脉注射罗库溴铵0.6 mg/kg,静脉输注异丙酚1 ～2 mg· kg-1·h-1.切皮即刻追加舒芬太尼0.10～ 0.15 μg/kg,术中间隔1h静脉注射罗库溴铵0.15mg/kg.记录穿刺深度、穿刺时间、穿刺成功情况.术毕患者完全清醒后,评价感觉阻滞情况.记录术后72 h内神经损伤、穿刺部位血肿和感染等的发生情况.结果 穿刺时间为(40±17)s,穿刺深度为(5.8±0.7) cm,一次性穿刺成功率为77％,感觉完全阻滞率为100％.术后随访未见神经损伤、穿刺部位血肿和感染等发生.结论 超声联合神经刺激仪引导下改良侧入路法坐骨神经阻滞术用于足部手术安全有效.
目的 評價超聲聯閤神經刺激儀引導改良側入路坐骨神經阻滯術用于足部手術的可行性.方法 擇期行足部手術患者62例,性彆不限,年齡18 ～ 60歲,BMI＜ 30 kg/m2,ASA分級Ⅰ-Ⅲ級.靜脈註射異丙酚2～4 mg/kg和舒芬太尼0.2 ～ 0.4 μg/kg痳醉誘導後置入喉罩併行機械通氣,持續吸入七氟醚.在超聲聯閤神經刺激儀引導下于改良側入路(股骨中上1/3附近)實施坐骨神經阻滯術,註入0.3％囉哌卡因30 ml.坐骨神經阻滯完成後,靜脈註射囉庫溴銨0.6 mg/kg,靜脈輸註異丙酚1 ～2 mg· kg-1·h-1.切皮即刻追加舒芬太尼0.10～ 0.15 μg/kg,術中間隔1h靜脈註射囉庫溴銨0.15mg/kg.記錄穿刺深度、穿刺時間、穿刺成功情況.術畢患者完全清醒後,評價感覺阻滯情況.記錄術後72 h內神經損傷、穿刺部位血腫和感染等的髮生情況.結果 穿刺時間為(40±17)s,穿刺深度為(5.8±0.7) cm,一次性穿刺成功率為77％,感覺完全阻滯率為100％.術後隨訪未見神經損傷、穿刺部位血腫和感染等髮生.結論 超聲聯閤神經刺激儀引導下改良側入路法坐骨神經阻滯術用于足部手術安全有效.
목적 평개초성연합신경자격의인도개량측입로좌골신경조체술용우족부수술적가행성.방법 택기행족부수술환자62례,성별불한,년령18 ～ 60세,BMI＜ 30 kg/m2,ASA분급Ⅰ-Ⅲ급.정맥주사이병분2～4 mg/kg화서분태니0.2 ～ 0.4 μg/kg마취유도후치입후조병행궤계통기,지속흡입칠불미.재초성연합신경자격의인도하우개량측입로(고골중상1/3부근)실시좌골신경조체술,주입0.3％라고잡인30 ml.좌골신경조체완성후,정맥주사라고추안0.6 mg/kg,정맥수주이병분1 ～2 mg· kg-1·h-1.절피즉각추가서분태니0.10～ 0.15 μg/kg,술중간격1h정맥주사라고추안0.15mg/kg.기록천자심도、천자시간、천자성공정황.술필환자완전청성후,평개감각조체정황.기록술후72 h내신경손상、천자부위혈종화감염등적발생정황.결과 천자시간위(40±17)s,천자심도위(5.8±0.7) cm,일차성천자성공솔위77％,감각완전조체솔위100％.술후수방미견신경손상、천자부위혈종화감염등발생.결론 초성연합신경자격의인도하개량측입로법좌골신경조체술용우족부수술안전유효.
Objective To evaluate the feasibility of modified lateral approach to sciatic nerve block guided by ultrasound and nerve stimulator for foot surgery.Methods Sixty-two patients of both sexes,aged 18-60 yr,with body mass index ＜ 30 kg/m2,of ASA physical status Ⅰ-Ⅲ,scheduled for elective foot surgery,were included in the study.Anesthesia was induced with iv propofol 2-4 mg/kg and sufentanil 0.2-0.4 μg/kg.The laryngeal mask airway was inserted and the patients were mechanically ventilated.Sevoflurane was inhaled continuously.Modified lateral approach to sciatic nerve block was performed with 0.3 ％ ropivacaine 30 ml under the guidance of the ultrasound combined with nerve stimulator.Rocuronium 0.6 mg/kg and propofol 1-2 mg· kg-1 · h-1 were administered after completion of sciatic nerve block.Additional sufentanil 0.10-0.15 μg/kg was intravenously injected immediately after skin incision and rocuronium 0.15 mg/kg was injected intravenously at 1 h intervals.The depth of puncture and time for puncture and success rate of puncture were recorded.Sensory block was assessed after the patients regained consciousness completely.Nerve injury,hematoma at the puncture site and infection within 72 h after surgery were recorded.Results The time for puncture was (40 ± 17) s.The depth of puncture was (5.8 ± 0.7) cm.The success rate of puncture at first attempt was 77 ％.The rate of complete sensory block was 100％.The post-operative follow-up showed that no patients developed nerve injury,hematoma or infection.Conclusion Modified lateral approach to sciatic nerve block guided by ultrasound and nerve stimulator is safe and effective for foot surgery.
