超声联合PNS神经阻滞在老年下肢骨科手术中的效果及对认知功能的影响

【目的】探讨超声联合外周神经刺激器(PNS)行腰丛-坐骨神经阻滞麻醉在老年下肢骨科手术中的应用价值。【方法】本院收治的160例拟实施腰丛-坐骨神经阻滞麻醉的下肢骨科手术的老年患者,随机分为两组,各80例;观察组采用超声联合PNS引导下实施腰丛-坐骨神经阻滞麻醉,对照组采用PNS引导定位实施腰丛-坐骨神经阻滞麻醉;对比两组不同时间点的血流动力学指标、简易智力状态量表(MMSE)评分及麻醉相关指标。【结果】阻滞前(T0)~阻滞后60min(T3)时,两组患者的收缩压(SBP)、舒张压(DBP)、心率(HR)值比较差异均无显著性(P>0.05);两组患者的SBP、DBP、HR监测值随着时间的变化,均较本组T。时刻发生了显著地波动,且差异具有选择性(P<0.05);麻醉前、麻醉后12h、24h、72h,两组患者的MMSE评分比较差异均无显著性(P>0.05);麻醉后12h和24h,两组患者的MMSE评分随着时间的变化,均较本组麻醉前时刻发生了先降低后升高的显著改变(P<0.05);观察组患者的感觉神经和运动神经阻滞起效时间均显著地低于对照组(P<0.05),观察组患者的感觉神经和运动神经阻滞维持时间均显著地高于对照组(P<0.05)。【结论】老年下肢骨科手术患者腰丛-坐骨神经阻滞麻醉中采用超声联合外PNS引导有利于提高定位的快速准确性,神经阻滞时间更长,但是对血流动力学的波动及认知功能的影响与单独应用PNS定位差异不大。

Effect of Ultrasound Combined with PNS on Anesthesia and Cognitive Function in Elderly Lower Extremity Orthopedic Surgery

【Objeetive】To explore the application value of ultrasound combined with peripheral nerve stim-ulator(PNS)in lumbar plexus-sciatic nerve block anesthesia for elderly lower extremity orthopedics.【Methods】A total of 160 elderly patients undergoing lumbar plexus-sciatic nerve block anesthesia orthopedic surgery from our hospital were selected and randomly divided into two groups with 80 cases each.The observation group was anesthetized with lum bar plexus-sciatic nerve block under the guidance of ultrasound combined PNS;the control group was anesthetized with lumbar plexus-sciatic nerve block by PNS guidance.Hem odynamic indexes,MMSE scores and anesthesia-related indexes were compared betw een the two groups at different time points.【Results】There was no significant difference in the systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)between the two groups of patients before(T0)to 60min(T3)after block(P>0.05).The changes in SBP,DBP,and HR monitoring values of patients in the two groups over time showed significant fluctuations compared to the time of TO in this group,and the differences were statistically significant(P<0.05).T here were no significant difference in the MMSE scores between the two groups before anesthesia and at 12h,24h and 72h after anesthesia(P>0.05).How ever,compared to the same group before anesthesia,the changes in MMSE scores of the two groups at 12h and 24h after anesthesia showed the pattern that decreased first and then increased(P<0.05).The onset time of sensory nerve and motor nerve block in the observation group was significantly lower than that in the control group(P<0.05).The maintenance time of sensory nerve and motor nerve block in the observation group was significantly longer than that in the control group(P<0.05).【Conclusion】In the elderly patients with lower extremity orthopedic surgery,the use of ultrasound combined with external PNS guidance in lumbar plexus-sciatic nerve block anesthesia is helpful to improve the rapid accuracy of positioning and prolong never block time.It does not show any impact on hemodynamic fluctuation and cognitive function comparing to PNS positioning alone.