联合引导腰丛- 坐骨神经阻滞的临床应用

Clinical application of ultrasound combined with nerve stimulator guiding lumbar plexus sciatic nerve block

摘要:

目的 评价超声联合神经刺激仪引导腰丛- 坐骨神经阻滞的效果及安全性。方法 择期拟行美国麻醉医师协会（ASA）Ⅲ、Ⅳ级患者单侧下肢手术患者60 例随机分为3 组（n =20），联合组于超声联合神经刺激仪引导下完成，超声组、神经刺激仪组分别于超声、神经刺激仪引导下完成腰丛- 坐骨神经阻滞后缓慢推注0.5% 盐酸罗哌卡因25 ml。记录3 组不同时刻血液动力学指标、神经阻滞完成时间、麻醉起效时间、镇痛维持时间、麻醉效果、辅助用药使用率及不良反应发生率。结果 3 组患者同时点比较及与同组T0 时刻比较，平均动脉压（MAP）及心率（HR）差异无统计学意义（P >0.05)。与神经刺激仪组比较，联合组及超声组神经阻滞完成时间、麻醉起效时间均降低，且术后镇痛维持时间均增加（P <0.05）；与超声组比较，联合组麻醉起效时间均降低，术后镇痛维持时间增加（P <0.05）。与神经刺激仪组比较，联合组及超声组不良反应发生率均降低（P <0.05）；与超声组比较，联合组不良反应差异无统计学意义（P >0.05)。结论 超声联合神经刺激仪引导腰丛- 坐骨神经阻滞应用于ASA Ⅲ - Ⅳ级患者单侧下肢手术效果较佳，可缩短操作时间、麻醉起效时间，且血流动力学平稳，并不增加不良反应发生率，临床应用安全。

Abstract:

Objective To evaluate the effect and safety of lumbar plexus sciatic nerve block guided by ultrasound combined with nerve stimulator in lower extremity surgery in patients with grade ASA Ⅲ , Ⅳ . Methods A total of 60 patients undergoing lower extremity surgery were randomly divided into 3 groups (n = 20).The combined group, ultrasound group and the nerve stimulator group were injected 25 ml of 0.5% Ropivacaine hydrochloride for lumbar plexus-sciatic nerve block guided by ultrasound combined with nerve stimulator, ultrasound only, and nerve stimulator only, respectively. Blood flow dynamics index at different time points, nerve block completion time, the onset time of anesthesia, duration of pain relief, anesthesia effect, usage rate of auxiliary medication and adverse reactions were compared among the three groups. Results MAP and HR had no significant difference at the same time point compared among three groups (P > 0.05); MAP and HR at different time points had no significant difference compared with those of T0 in three groups respectively (P > 0.05). The nerve block completion time and the onset time of anesthesia in the combination group and the ultrasound group were significantly shorter than those of the nerve stimulator group (P < 0.05)，and the duration of pain relief in the combination group and the ultrasound group was significantly longer than that of the nerve stimulator group (P < 0.05); In the combined group, the onset time of anesthesia was significantly shorter and the duration of pain relief was significantly longer than those of the ultrasound group (P < 0.05). Compared with the nerve stimulator group, the rate of adverse reaction in the combined group and the ultrasound group was significantly decreased (P < 0.05); there was no significant difference between the combined group and the ultrasound group in the rate of adverse reaction (P > 0.05). Conclusion The effect of Ultrasound combined with nerve stimulator guided lumbar plexus sciatic nerve block in ASA Ⅲ - Ⅳ patients undergoing unilateral lower extremity surgery is better by shortening the operation time and anesthesia onset time,providing a stable hemodynamics, and keeping clinical safety for not increasing the incidence of adverse reaction.