江西医药
江西醫藥
강서의약
JIANGXI MEDICAL JOURNAL
2014年
12期
1365-1367
,共3页
腰丛加坐骨神经阻滞%高龄老人%髋关节置换术
腰叢加坐骨神經阻滯%高齡老人%髖關節置換術
요총가좌골신경조체%고령노인%관관절치환술
Combined lumbar plexus-sciatic nerve block%Elderly patientship replacement%Hemiarthroplasty
目的：探讨选择性腰丛加坐骨神经阻滞麻醉在高龄老人髋关节置换术中的可行性。方法高龄老人髋关节置换术采用连续硬膜外麻醉或全身气管内插管麻醉与选择性腰丛加坐骨神经阻滞作为对照，观察其对老年病人血流动力学的影响。选择60例拟行半髋关节置换手术的高龄老年患者，选择麻醉方式随机分为腰丛加坐骨神经阻滞组(A组)、硬膜外阻滞组(B 组)、和全身麻醉气管内插管组(C 组)。记录麻醉前、麻醉药物使用后1min、5min、10min、30min 的收缩压（SBP），舒张压（DBP），心率（HR）及相关副作用。结果 A组在麻醉药物使用后1min、5min、10min、30min的SBP，DBP及HR非常稳定。B组在麻醉药物使用后10min的SBP、DBP、HR明显低于A组，30min的SBP，DBP也有所降低。 C组在麻醉药物使用后SBP、DBP、HR后1min即明显低于A组。 A组患者接受该麻醉操作后无副作用，B组和C组患者需要术后导尿预防尿潴留。 C组患者接受气管插管麻醉苏醒后咽喉异物感强烈。结论选择性腰丛加坐骨神经阻滞在高龄老人髋关节置换术的应用成功率高，血流动力学平稳，麻醉范围局限对机体影响小，无胃肠道反应和尿潴留现象发生，是高龄老人髋关节置换术的理想麻醉方法。
目的：探討選擇性腰叢加坐骨神經阻滯痳醉在高齡老人髖關節置換術中的可行性。方法高齡老人髖關節置換術採用連續硬膜外痳醉或全身氣管內插管痳醉與選擇性腰叢加坐骨神經阻滯作為對照，觀察其對老年病人血流動力學的影響。選擇60例擬行半髖關節置換手術的高齡老年患者，選擇痳醉方式隨機分為腰叢加坐骨神經阻滯組(A組)、硬膜外阻滯組(B 組)、和全身痳醉氣管內插管組(C 組)。記錄痳醉前、痳醉藥物使用後1min、5min、10min、30min 的收縮壓（SBP），舒張壓（DBP），心率（HR）及相關副作用。結果 A組在痳醉藥物使用後1min、5min、10min、30min的SBP，DBP及HR非常穩定。B組在痳醉藥物使用後10min的SBP、DBP、HR明顯低于A組，30min的SBP，DBP也有所降低。 C組在痳醉藥物使用後SBP、DBP、HR後1min即明顯低于A組。 A組患者接受該痳醉操作後無副作用，B組和C組患者需要術後導尿預防尿潴留。 C組患者接受氣管插管痳醉囌醒後嚥喉異物感彊烈。結論選擇性腰叢加坐骨神經阻滯在高齡老人髖關節置換術的應用成功率高，血流動力學平穩，痳醉範圍跼限對機體影響小，無胃腸道反應和尿潴留現象髮生，是高齡老人髖關節置換術的理想痳醉方法。
목적：탐토선택성요총가좌골신경조체마취재고령노인관관절치환술중적가행성。방법고령노인관관절치환술채용련속경막외마취혹전신기관내삽관마취여선택성요총가좌골신경조체작위대조，관찰기대노년병인혈류동역학적영향。선택60례의행반관관절치환수술적고령노년환자，선택마취방식수궤분위요총가좌골신경조체조(A조)、경막외조체조(B 조)、화전신마취기관내삽관조(C 조)。기록마취전、마취약물사용후1min、5min、10min、30min 적수축압（SBP），서장압（DBP），심솔（HR）급상관부작용。결과 A조재마취약물사용후1min、5min、10min、30min적SBP，DBP급HR비상은정。B조재마취약물사용후10min적SBP、DBP、HR명현저우A조，30min적SBP，DBP야유소강저。 C조재마취약물사용후SBP、DBP、HR후1min즉명현저우A조。 A조환자접수해마취조작후무부작용，B조화C조환자수요술후도뇨예방뇨저류。 C조환자접수기관삽관마취소성후인후이물감강렬。결론선택성요총가좌골신경조체재고령노인관관절치환술적응용성공솔고，혈류동역학평은，마취범위국한대궤체영향소，무위장도반응화뇨저류현상발생，시고령노인관관절치환술적이상마취방법。
Objective To discuss the possibility of the combination use of selective lumber plexus and sciatic nervse block for old patients undergoing hip joint replacement surgery. Methods Compared to the epidural anesthesia or general anesthesia,the effect of hemodynamic responses with combined lumbar plexus-sciatic nerve block was discussed in advanced age patients fol-lowed hemiarthroplasty. Random selection and allocation was taken to averagely divide 60 elderly patients followed hemiarthroplas-ty into three groups:Combined lumbar plexus-sciatic nerve block (Group A);the epidural anesthesia (Group B);general anesthesia (Group A). To evaluate the effect of hemodynamic responses by observing SBP,DBP and HR before and1,5,10,30miniutes after anesthetic administration. Results The SBP、DBP、HR remains stable after 1,5,10,30miniutes followed anesthetic medication in group A;SBP、DBP、HR were lower,after 10minites in Group B and 1minite in Group C than in group A followed anesthetic medi-cation and so were SBP,DBP after 30minites followed anesthetic medication in group B. Conclusion With the advantages of a high successful rate,steady hemodynamics,less physical damage and complication such as the gastrointestinal tract reaction and urinary retention,combined selected lumbar plexus-sciatic nerve block is considered as a good choice for elderly patients followed hip replacement surgery.
