选择性腰丛加坐骨神经阻滞在高龄老人髋关节置换术的临床应用

摘要

目的：探讨选择性腰丛加坐骨神经阻滞麻醉在高龄老人髋关节置换术中的可行性。方法高龄老人髋关节置换术采用连续硬膜外麻醉或全身气管内插管麻醉与选择性腰丛加坐骨神经阻滞作为对照，观察其对老年病人血流动力学的影响。选择60例拟行半髋关节置换手术的高龄老年患者，选择麻醉方式随机分为腰丛加坐骨神经阻滞组(A组)、硬膜外阻滞组(B 组)、和全身麻醉气管内插管组(C 组)。记录麻醉前、麻醉药物使用后1min、5min、10min、30min 的收缩压（SBP），舒张压（DBP），心率（HR）及相关副作用。结果 A组在麻醉药物使用后1min、5min、10min、30min的SBP，DBP及HR非常稳定。B组在麻醉药物使用后10min的SBP、DBP、HR明显低于A组，30min的SBP，DBP也有所降低。 C组在麻醉药物使用后SBP、DBP、HR后1min即明显低于A组。 A组患者接受该麻醉操作后无副作用，B组和C组患者需要术后导尿预防尿潴留。 C组患者接受气管插管麻醉苏醒后咽喉异物感强烈。结论选择性腰丛加坐骨神经阻滞在高龄老人髋关节置换术的应用成功率高，血流动力学平稳，麻醉范围局限对机体影响小，无胃肠道反应和尿潴留现象发生，是高龄老人髋关节置换术的理想麻醉方法。%Objective To discuss the possibility of the combination use of selective lumber plexus and sciatic nervse block for old patients undergoing hip joint replacement surgery. Methods Compared to the epidural anesthesia or general anesthesia,the effect of hemodynamic responses with combined lumbar plexus-sciatic nerve block was discussed in advanced age patients fol-lowed hemiarthroplasty. Random selection and allocation was taken to averagely divide 60 elderly patients followed hemiarthroplas-ty into three groups:Combined lumbar plexus-sciatic nerve block (Group A);the epidural anesthesia (Group B);general anesthesia (Group A). To evaluate the effect of hemodynamic responses by observing SBP,DBP and HR before and1,5,10,30miniutes after anesthetic administration. Results The SBP、DBP、HR remains stable after 1,5,10,30miniutes followed anesthetic medication in group A;SBP、DBP、HR were lower,after 10minites in Group B and 1minite in Group C than in group A followed anesthetic medi-cation and so were SBP,DBP after 30minites followed anesthetic medication in group B. Conclusion With the advantages of a high successful rate,steady hemodynamics,less physical damage and complication such as the gastrointestinal tract reaction and urinary retention,combined selected lumbar plexus-sciatic nerve block is considered as a good choice for elderly patients followed hip replacement surgery.