| 摘要: |
| ［摘要］ 目的 比较老年患者单侧下肢手术中C型臂引导下行腰丛联合坐骨神经阻滞与硬膜外麻醉的效果。方法 选择60例ASAⅠ～Ⅲ级拟行单侧下肢手术患者，根据随机余数法分为腰丛联合坐骨神经阻滞组(A组,n=30)和硬膜外麻醉组(B组，n=30),A组在C臂引导下行腰丛联合坐骨神经阻滞，两点分别给予0.375%罗哌卡因30 ml（腰丛）、20 ml（坐骨神经）；B组行硬膜外麻醉，给予0.375%罗哌卡因10～15 ml。观察两组不同时点血流动力学变化、阻滞效果及其不良反应。结果 A组在手术过程中的收缩压、舒张压、心率较B组平稳；A组用麻黄碱的患者显著少于B组（P<0.01）；A组患者感觉神经阻滞起效时间长于B组（P<0.01），但A组感觉神经及运动神经阻滞维持时间均明显长于B组(P<0.01)；B组围术期出现恶心、呕吐、尿潴留不良反应明显高于A组(P<0.01)。结论 腰丛联合坐骨神经阻滞用于老年患者单侧下肢手术，不仅可满足手术需要，而且对老年患者血流动力学影响小，并发症少，镇痛维持时间长，不良反应少。尤其适合年老体弱患者的手术。 |
| 关键词: 神经传导阻滞 C型臂引导下 老年人 麻醉 下肢手术 |
| DOI：10.3969/j.issn.1674-3806.2015.12.13 |
| 分类号:R 614.4 |
| 基金项目: |
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| Clinical application of C-arm guided lumbar plexus and sciatic nerve blockade on elderly patients with lower limb surgery |
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TIAN Wen-hua, GAO Song, YANG Fan, et al.
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Department of Anesthesiology, Hankou Hospital of Wuhan City, Hubei 430012, China
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| Abstract: |
| ［Abstract］ Objective To compare the effects of C-arm guided lumbar plexus and sciatic nerve blockade and epidural anesthesia on elderly patients with lower limb surgery.Methods Sixty elderly cases(ASAⅠ～Ⅲ) were divided into the lumbar plexus and sciatic nerve blockade group(group A, n=30) and the epidural anesthesia group(group B, n=30). Patients in group A received C-arm guided lumbar plexus and sciatic nerve blockade, with 30 ml and 20 ml of 0.375% ropivacaine administrated to the lumbar plexus and sciatic nerve respectively; Patients in group B received epidural anesthesia and were administrated with 10～15 ml of 0.375% ropivacaine. Hemodynamic changes, the effects of blockade and adverse reactions were observed in both groups.Methods The systolic pressure, diastolic pressure and heart rate in group A were more stable than those in group B. The number of patients using ephedrine in group A was much smaller than that in group B（P<0.01）. The sensory block onset time of group A was longer than that of group B（P<0.01）, while the hold time of sensory and motor nerve block onset time of group A was significantly longer than that of group B(P<0.01). Adverse reactions such as nausea, vomit and retention of urine in group B during the preoperative period were much more severe than those in group A(P<0.01).Conclusion The application of lumbar plexus and sciatic nerve blockade in unilateral lower limb surgery can not only meet the surgical requirements, but also have a small impact on hemodynamics, less complications, longer duration of pain relief and less adverse reactions. Therefore, it is especially suitable for frail elderly patients. |
| Key words: Nerve block C-arm guided Elderly people Anesthesia Lower limb surgery |
