腰丛-坐骨神经阻滞用于老年患者下肢骨科手术200例

摘要

目的 探讨腰丛-坐骨神经阻滞在老年患者下肢骨科手术中的临床疗效.方法 将400例行下肢骨科手术的老年患者按随机数字分表法分为对照组和观察组,各200例,分别给予腰-硬膜外联合麻醉与腰丛-坐骨神经阻滞.结果 对照组的心率在注药5,10 min时明显增快,但观察组在各时点无明显差异;两组平均动脉压在注药5,10,30 min时明显降低,但对照组的波动较观察组明显( P<0. 05);观察组的感觉阻滞持续时间明显长于对照组,运动阻滞持续时间明显短于对照组( P<0. 05);观察组术后出现胃肠道不适、尿潴留和低血压的发生率均明显低于对照组( P<0. 05).结论 腰丛-坐骨神经阻滞应用于老年患者下肢骨科手术中可有效维持血流动力学稳定,镇痛完善麻醉效果可靠,并减少术后并发症的发生,安全性高.%Objective To explore the clinical efficacy of lumbar plexus-sciatic nerve block used in lower extremities operation of elderly patients. Methods 400 cases of elderly patients who were treated with lower extremities operation were selected and divided into the control group and the observation group according to the random number table method, 200 cases in each group. The two groups were given lumbar-epidural combined with anesthesia and lumbar plexus-sciatic nerve block respectively. Results HR of the control group was obviously increased at 5, 10 min of injection, but the observation group showed stability at all time points. MAP of two groups obviously increased at 5, 10, 30 min of injection, but the fluctuations in the control group was more significant than the observation group ( P < 0. 05 ) . The duration of sensory blockade in the observation group was obviously longer than the control group, and the motion block duration was obviously shorter than the control group ( P < 0. 05 ) . Postoperative gastrointestinal discomfort, urinary retention and the incidence rate of hypotension in the observation group were significantly lower than those in the control group. Conclusion Lumbar plexus-sciatic nerve block used in lower extremities operation of elderly patients can effectively maintain hemodynamic stability, and has perfect analgesic effect and reliable anesthetic effect, and reduces the occurrence of postoperative complications. Its safety is high and is worthy of clinical promotion.