超声引导前路坐骨、股神经阻滞在腰椎疾病下肢手术的应用研究(1)
摘 要：目的 探讨超声引导下前路坐骨神经、股神经阻滞麻醉联合全身麻醉在腰椎疾病行下肢手术中的应用可行性。方法 选取2016年12月～2017年6月于我院行下肢手术的腰椎疾病患者80例，随机分为观察组和对照组，各40例，对照组患者行单纯全身麻醉，观察组在全身麻醉的同时联合B超引导前路坐骨神经、股神经阻滞。分析两组患者的术后苏醒时间、苏醒后躁动情况及麻醉药物的用量。结果 观察组患者手术中麻醉药物用量少于对照组，患者的拔管时间及苏醒时间也比对照组短，差异具有统计学意义(P<0.05)。观察组患者苏醒后的躁动情况发生率及躁动程度均低于对照组，差异具有统计学意义(P<0.05)。结论 超声引导下前路坐骨神经、股神经阻滞联合全身麻醉在腰椎疾病患者中，能够减少镇痛药物用量，维持稳定的术中血流，提高镇痛效果，促进拔管与早期活动，是理想的下肢骨折手术麻醉方式。
关键词：超声引导；神经阻滞；全身麻醉；下肢骨折手术
中图分类号：R614.4；R614.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.02.035
, 百拇医药
文章编号：1006-1959(2018)02-0101-02
Abstract：Objective To investigate the feasibility of ultrasound-guided anterior sciatic nerve and femoral nerve block anesthesia combined with general anesthesia in lumbar surgery.Methods 80 patients with lumbar spine disease undergoing lower extremity operation in our hospital from December 2016 to June 2017 were randomly divided into observation group and control group，40 cases in each group，patients in the control group underwent general anesthesia.The observation group underwent general anesthesia combined with B-guided anterior sciatic nerve and femoral nerve block.Analysis of two groups of patients after the recovery time，wake up after the rest and the amount of anesthetic drugs.Results The amount of anesthetic used in the observation group was less than that of the control group.The extubation time and recovery time were also shorter in the observation group than in the control group，the difference was statistically significant(P<0.05).The incidence of restlessness and degree of restlessness in the observation group were lower than those in the control group after awakening，the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided anterior sciatic nerve and femoral nerve block combined with general anesthesia can reduce the dosage of analgesic drugs maintain stable intraoperative blood flow improve the analgesic effect and promote extubation and early activity in patients with lumbar vertebrae disease.It is an ideal anaesthesia for lower limb fracture surgery.
, http://www.100md.com
Key words：Ultrasonic guidance；Nerve block；General anesthesia；Lower extremity fracture surgery
下肢骨折常用治疗方式为手术治疗，但存在时手术时间长、手术难度大及对患者呼吸系统与循环系统影响大的缺点，尤其合并腰椎骨折或腰椎间盘突出症对麻醉安全性与有效性要求更高[1]。合并腰部疾病的患者临床上以全身麻醉为主，具有确切的疗效，但其对血流动力学影响较大，患者出现明显的应激反应[2]。近年来外周区域神经阻滞的相关研究逐渐增多，其对循环系统及呼吸系统干扰小，并发症与相關禁忌症也更少。其镇痛关键在于保证麻醉药物充分扩散于神经区域，以超声阻滞最为确切。本课题对超声引导下前路坐骨神经、股神经阻滞与全身麻醉在腰部疾病导致需给予下肢骨折手术中联合应用的可行性进行探讨。
1 资料与方法
1.1一般资料 选取2016年6月～2017年6月于兰陵县人民医院择期进行下肢手术治疗的患者80例，所有患者都患有严重腰椎间盘突出症或者高处坠落伤导致的腰椎骨折。美国麻醉师协会(ASA)分级Ⅰ～Ⅲ级，所有患者均签署知情同意书，近期均未使用过糖皮质激素，均无周围神经阻滞禁忌证，排除内分泌系统疾病、对麻醉药物过敏、意识障碍者[3]。所有患者随机分为两组，即对照组与观察组，每组各40例患者。对照组中男22例，女18例，年龄30～63岁，平均年龄(47.86±5.48)岁，BMI 18～28 kg/m2，平均BMI(21.96±3.21)kg/m2，合并冠心病5例，糖尿病7例，陈旧性心肌梗死2例；高血压10例，手术类型：胫腓骨骨折内固定术26例，足踝跟骨骨折内固定术15例。观察组中男21例，女19例，年龄30～64岁，平均年龄(47.90±5.52)岁，BMI 18～30kg/m2，平均BMI(22.01±3.18)kg/m2，合并冠心病4例，糖尿病4例，陈旧性心肌梗死4例；高血压11例，手术类型：胫腓骨骨折内固定术22例，足踝跟骨骨折内固定术17例。两组患者在年龄、性别及病情等方面差异无统计学意义(P>0.05)，可以进行比较。, http://www.100md.com(张明东 王士雷)
关键词：超声引导；神经阻滞；全身麻醉；下肢骨折手术
中图分类号：R614.4；R614.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.02.035
, 百拇医药
文章编号：1006-1959(2018)02-0101-02
Abstract：Objective To investigate the feasibility of ultrasound-guided anterior sciatic nerve and femoral nerve block anesthesia combined with general anesthesia in lumbar surgery.Methods 80 patients with lumbar spine disease undergoing lower extremity operation in our hospital from December 2016 to June 2017 were randomly divided into observation group and control group，40 cases in each group，patients in the control group underwent general anesthesia.The observation group underwent general anesthesia combined with B-guided anterior sciatic nerve and femoral nerve block.Analysis of two groups of patients after the recovery time，wake up after the rest and the amount of anesthetic drugs.Results The amount of anesthetic used in the observation group was less than that of the control group.The extubation time and recovery time were also shorter in the observation group than in the control group，the difference was statistically significant(P<0.05).The incidence of restlessness and degree of restlessness in the observation group were lower than those in the control group after awakening，the difference was statistically significant(P<0.05).Conclusion Ultrasound-guided anterior sciatic nerve and femoral nerve block combined with general anesthesia can reduce the dosage of analgesic drugs maintain stable intraoperative blood flow improve the analgesic effect and promote extubation and early activity in patients with lumbar vertebrae disease.It is an ideal anaesthesia for lower limb fracture surgery.
, http://www.100md.com
Key words：Ultrasonic guidance；Nerve block；General anesthesia；Lower extremity fracture surgery
下肢骨折常用治疗方式为手术治疗，但存在时手术时间长、手术难度大及对患者呼吸系统与循环系统影响大的缺点，尤其合并腰椎骨折或腰椎间盘突出症对麻醉安全性与有效性要求更高[1]。合并腰部疾病的患者临床上以全身麻醉为主，具有确切的疗效，但其对血流动力学影响较大，患者出现明显的应激反应[2]。近年来外周区域神经阻滞的相关研究逐渐增多，其对循环系统及呼吸系统干扰小，并发症与相關禁忌症也更少。其镇痛关键在于保证麻醉药物充分扩散于神经区域，以超声阻滞最为确切。本课题对超声引导下前路坐骨神经、股神经阻滞与全身麻醉在腰部疾病导致需给予下肢骨折手术中联合应用的可行性进行探讨。
1 资料与方法
1.1一般资料 选取2016年6月～2017年6月于兰陵县人民医院择期进行下肢手术治疗的患者80例，所有患者都患有严重腰椎间盘突出症或者高处坠落伤导致的腰椎骨折。美国麻醉师协会(ASA)分级Ⅰ～Ⅲ级，所有患者均签署知情同意书，近期均未使用过糖皮质激素，均无周围神经阻滞禁忌证，排除内分泌系统疾病、对麻醉药物过敏、意识障碍者[3]。所有患者随机分为两组，即对照组与观察组，每组各40例患者。对照组中男22例，女18例，年龄30～63岁，平均年龄(47.86±5.48)岁，BMI 18～28 kg/m2，平均BMI(21.96±3.21)kg/m2，合并冠心病5例，糖尿病7例，陈旧性心肌梗死2例；高血压10例，手术类型：胫腓骨骨折内固定术26例，足踝跟骨骨折内固定术15例。观察组中男21例，女19例，年龄30～64岁，平均年龄(47.90±5.52)岁，BMI 18～30kg/m2，平均BMI(22.01±3.18)kg/m2，合并冠心病4例，糖尿病4例，陈旧性心肌梗死4例；高血压11例，手术类型：胫腓骨骨折内固定术22例，足踝跟骨骨折内固定术17例。两组患者在年龄、性别及病情等方面差异无统计学意义(P>0.05)，可以进行比较。, http://www.100md.com(张明东 王士雷)