目的 探讨神经刺激仪引导的腰丛及坐骨神经阻滞在老年下肢手术中的应用效果。方法 选择阳江市阳东区人民医院麻醉科2019年1月—2021年11月开展下肢手术的老年患者76例,采用随机数字表法分为常规组与观察组（38例/组）,常规组采用连续硬膜外麻醉,观察组采用神经刺激仪引导的腰丛及坐骨神经阻滞。观察两组麻醉前（T0）、麻醉后30 min（T1）、麻醉后60 min（T2）、术后1 h（T3）患者血流动力学（收缩压（SBP）、舒张压（DBP）、心率（HR））,比较两组麻醉情况、麻醉效果及不良反应发生情况。结果 常规组与观察组在T0、T1、T2、T3时SBP、DBP、HR水平差异无统计学意义（P>0.05）;常规组与观察组感觉、运动阻滞起效时间比较,差异无统计学意义（P>0.05）,观察组感觉、运动维持时间长于常规组,差异有统计学意义（P<0.05）;观察组麻醉效果优于常规组,不良反应发生率低于常规组,差异有统计学意义（P<0.05）。结论 神经刺激仪引导的腰丛及坐骨神经阻滞在老年下肢手术中应用,可稳定患者血流动力学,增强感觉、运动阻滞维持时间,麻醉效果好,安全性高。
Objective To investigate the effect of lumbar plexus and sciatic nerve block guided by nerve stimulator in elderly lower limb surgery. Methods A total of 76 elderly patients with lower limb surgery were selected from the Department of Anesthesiology of Yangdong District People’s Hospital, Yangjiang City from January 2019 to November 2021. They were divided into a routine group and an observation group （38 cases in each group） by random number table method; the routine group adopted continuous epidural anesthesia, and the observation group adopted a nerve stimulator-guided lumbar plexus and sciatic nerve block. The hemodynamics [systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and heart rate （HR）] before anesthesia （T0）, 30 min after anesthesia （T1）, 60 min after anesthesia （T2）, and 1 h after surgery （T3）], anesthesia conditions, anesthesia effect, and adverse reactions were compared between two groups. Results There were no significant differences in SBP, DBP, and HR between the routine group and the observation group at T0, T1, T2, and T3 （P>0.05）; there were no significant differences in the onset time of sensory and motor block between the two groups （P>0.05）, and the observation group maintained longer sensation and movement than the routine group （P<0.05）; the observation group showed a better anesthesia effect and a lower incidence rate of adverse reactions than the routine group （P<0.05）. Conclusion Lumbar plexus and sciatic nerve block guided by nerve stimulator for elderly lower extremity surgery can stablize patient's hemodynamics, enhance the maintainance of sensory and motor block, and has a good anesthesia effect with high safety.
[1] 王秀环,鲍乐乐,马漪洁,等. 不同麻醉方法对老年髋关节置换患者术后谵妄发生的影响[J]. 广州医科大学学报,2021,49(2):40-44.
[2] 胡小雪,金忆,李建松,等. 精准麻醉管理对老年患者髋关节置换术后应激反应及认知功能的影响[J]. 贵州医药,2021,45(4):559-561.
[3] 张健,蒋协远,黄晓文. 1 139例老年髋部骨折治疗及流行病学分析[J]. 中国医刊,2016,51(6):91-94.
[4] 赵劲松,蒋永宽,韩娟英. 硬膜外自控镇痛与收肌管隐神经置管连续阻滞用于老年内踝骨折患者术后镇痛效果的研究[J]. 中国基层医药,2017,24(24):3803-3806.
[5] 胡敬锋,朱剑斌,姜闽英. 神经刺激仪引导的腰丛及坐骨神经阻滞在老年下肢手术的应用[J]. 广东医学,2016,37(12):1850-1852.
[6] 刘星星,贺清明. 老年髋部骨折病人肺部感染危险因素的Meta分析[J]. 护理研究,2021,35(2):195-205.
[7] 熊焕威. 连续硬膜外麻醉与腰麻对老年下肢骨折患者循环系统的影响[J]. 基层医学论坛,2020,24(2):227-228.
[8] 杨鹏,王薇,李丹,等. 腰丛-坐骨神经阻滞在老年股骨颈骨折内固定术中的应用[J]. 医学综述,2018,24(5):1024-1028.
[9] Subramaniam B, Shankar P, Shaefi S, et al.Effect of intravenous acetaminophen vs placebo combined with propofol or dexmedetomidine on postoperative delirium among older patients following cardiac surgery: The DEXACET randomized clinical trial[J]. JAMA, 2019, 321(7): 686-696.
[10] Lim BG, Lee IO.Anesthetic management of geriatric patients[J]. Korean J Anesthesiol, 2020, 73(1): 8-29.
[11] Horasanli E, Gamli M, Pala Y.A comparison of epidural anesthesia and lumbar plexus-sciatic nerve blocks for knee surgery[J]. Clinics (Sao Paulo), 2010, 65(1): 29-34.
[12] 李莲娣,苗慧,岳文江,等. 不同麻醉方式在老年下肢手术中麻醉效果及对术后转归的影响[J]. 中国卫生标准管理,2020,11(15):125-127.
[13] 陈慧娜,郝玉民,杨立峰,等. 超声引导下腰丛坐骨神经阻滞对老年人全膝关节置换术炎症反应的影响[J]. 海南医学,2021,32(12):1579-1583.
[14] 税俊文,刘箐. 超声引导下腰丛复合坐骨神经阻滞麻醉用于老年股骨粗隆间骨折的临床研究[J]. 基层医学论坛,2021,25(26):3717-3718.
[15] 蔡宜良,陈家趁,曹玉云,等. 超声和神经刺激仪引导下肌间沟臂丛阻滞用于锁骨骨折的效果[J]. 安徽医药,2021,25(4):740-743.
[16] Shehabi Y, Howe BD, Bellomo R, et al.Early sedation with dexmedetomidine in critically ill patients[J]. N Engl J Med, 2019, 380(26): 2506-2517.
