股神经-坐骨神经联合阻滞在高龄患者单下肢手术中的临床应用

目的探讨应用神经刺激器行股神经-坐骨神经联合阻滞的方法用于高龄患者单下肢手术中的效果。方法将30例75岁以上、ASA分级Ⅱ-Ⅲ级、拟行单侧下肢手术的老年患者按随机数字表法分为2组,每组15例。A组采用神经刺激器定位技术,正确定位后,坐骨神经和股神经分别给予0.4%罗哌卡因20mL和25mL阻滞;B组选择L3-4或L2-3间隙行蛛网膜下腔麻醉,给予0.75%布比卡因1.2mL+10%葡萄糖0.1mL。对2组患者麻醉前,麻醉后15、30min,手术结束时SBP、DBP和HR的变化及不良反应的发生率进行比较。结果 2组患者麻醉效果均满意,阻滞效果及HR的变化比较差异均无统计学意义(均P>0.05)。麻醉前2组患者的SBP、DBP比较差异均无统计学意义(均P>0.05);麻醉后B组15、30min的SBP、DBP均明显低于麻醉前及A组(均P<0.05)。B组围术期不良反应(恶心呕吐、尿潴留等)的发生率为66.7%,A组未出现不良反应,B组明显高于A组(P<0.01)。结论神经刺激器定位股神经-坐骨神经阻滞用于高龄患者单下肢手术阻滞成功率较高,对循环功能影响较小,术后并发症少。

Application of Continuous Femoral and Sciatic Nerve Block in Unilateral Lower Limb Surgery in Elderly Patients

Objective To investigate the efficiency of nerve stimulation guidance for continuous femoral and sciatic nerve block in unilateral lower limb surgery in elderly patients.Methods Thirty ASAⅡ-Ⅲ patients over 75 years old who were scheduled to undergo unilateral lower limb surgery were randomly allocated into two groups,with 15 patients in each group.In group A,the femoral and sciatic nerves were located using a nerve stimulator and were injected with 20 mL and 25 mL of 0.4% ropivacaine,respectively.In group B,1.2 mL of 0.75 % bupivacaine and 0.1 mL of 10% glucose were injected at spinal interspace L3-4 or L2-3 for subarachnoid anesthesia.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR） and complications were observed before anesthesia,15 and 30 minutes after anesthesia and at the end of operation,and were compared between the two groups.Results Patients were satisfied with the anesthetic effects,and no significant differences were found in block efficiency and change in HR between the two groups（P0.05）.The SBP and DBP in group A were not significantly different from those in group B before anesthesia（P0.05）,but obviously lower than those in group B at 15 and 30 minutes after anesthesia（P0.05）.The incidence of perioperative complications（nausea,vomit,uroschesis,etc.） was 0% and 66.7% in group A and group B,respectively.Conclusion The application of continuous femoral and sciatic nerve block has a higher success rate in unilateral lower limb surgery in elderly patients,with smaller effect on circulatory function and less postoperative complications.