目的 比较神经刺激仪引导下的腰丛-坐骨神经阻滞与蛛网膜下腔神经阻滞在单侧下肢手术中的临床效果。方法 择期行单侧下肢手术的ASA I~Ⅱ级患者60例,按随机数字法分为腰丛复合坐骨神经阻滞组(研究组)和蛛网膜下腔神经阻滞组(对照组)各30例。研究组行神经刺激仪辅助下腰丛-坐骨神经联合阻滞,腰丛阻滞剂量为0.5%罗哌卡因20 mL,坐骨神经阻滞剂量为0.5%罗哌卡因15 mL。对照组行蛛网膜下腔神经阻滞麻醉,腰穿成功后,给予0.5%布比卡因2.5 mL,分别记录麻醉前5 min(T₀)、麻醉后5 min(T₁)、手术开始时(T₂)、手术开始后30 min(T₃)和手术结束时(T₄)患者的心率(HR)、平均动脉压(MAP)、呼吸(RR)和血氧饱和度(SPO₂);记录感觉和运动阻滞起效时间,感觉及运动恢复时间,同时记录舒芬太尼使用率、麻黄碱使用率及术后不良事件(恶心、瘙痒、低血压及尿潴留)的发生率。结果 对照组的感觉和运动阻滞起效时间均短于研究组,差异有统计学意义(P<0.05)。研究组麻醉前5 min(T₀)的HR、MAP、RR和SPO₂与对照组比较,差异无统计学意义(P>0.05);研究组在麻醉后5 min(T₁)、手术开始时(T₂)、手术开始后30 min(T₃)和手术结束时(T₄)的HR均低于对照组,差异有统计学意义(P<0.05);研究组在手术结束时(T₄)的MAP高于对照组,差异有统计学意义(P<0.05);两组舒芬使用率差异无统计学意义,但研究组的麻黄碱使用率低于对照组,差异有统计学意义(P<0.05);研究组患者术后不良反应发生率(恶心、瘙痒、尿潴留及低血压)均低于对照组,差异具有统计学意义(P<0.05)。结论 在单侧下肢手术中,与蛛网膜下腔神经阻滞相比,腰丛-坐骨神经阻滞的血流动力学更稳定,术后并发症少。

Objective To compare the clinical effects of lumbar plexus-sciatic nerve block versus subarachnoid nerve block on unilateral lower limb surgery.Methods A total of 60 patients with ASA I-II who underwent unilateral lower extremity surgery were randomly divided by random number table into lumbar plexus-sciatic nerve block group (group A) and subarachnoid nerve block group (group B), with 30 cases in each group.Group A underwent nerve stimulator-assisted lumbar plexus-sciatic nerve combined block, using 0.5% ropivacaine at 20 mL for lumbar plexus block and 0.5% ropivacaine at 15 mL for sciatic nerve block; while group B received subarachnoid nerve block anesthesia, with 0.5% ropivacaine at 10-15 mL.Heart rate (HR), mean arterial pressure (MAP), respiration rate (RR), and oxygen saturation (SPO₂) were recorded at 5 min before anesthesia (T₀), 5 min after anesthesia (T₁), beginning of surgery (T₂), 30 min after the start of surgery (T₃), and end of surgery(T₄); sensory and motor block onset time, sensory and motor recovery time, sufentanil usage, ephedrin usage, and postoperative adverse events (nausea, pruritus, hypotension, and urinary retention) were also recorded.Results The sensory and motor block onset time in group A was statistically shorter than that in group B (P<0.05).At T₀, HR, MAP, RR, and SPO₂ were not different between group A and group B (P>0.05); at T₁, T₂, T₃, and T₄, HR in group A was significantly lower than that in group B (P<0.05); at T₄, MAP in group A was significantly higher than in that in group B (P<0.05).The sufentanil use rate was not different between the two groups, but the ephedrin use rate in group A was significantly lower than that in group B (P<0.05).The rates of adverse reactions in group A (nausea, pruritus, urinary retention, and hypotension) were significantly lower than those in group B (P<0.05).Conclusion Compared with subarachnoid nerve block, lumbar plexus-sciatic nerve block shows more stable hemodynamics and less postoperative complications in unilateral lower limb surgery.