超声引导下大腿中下段旁外侧入路与经典Labat入路坐骨神经阻滞的临床比较

摘要

目的 比较超声引导下大腿中下段旁外侧入路与经典Labat入路坐骨神经阻滞的临床效果.方法 选择在我院接受下肢远端骨折手术的患者120例,随机分为大腿中下段旁外侧入路( A组)和经典Labat入路( B组),每组各60例.两组患者先行股神经阻滞后,再分别完成不同入路的坐骨神经阻滞.记录患者超声识别坐骨神经情况,坐骨神经阻滞后起效时间,坐骨神经阻滞持续时间.记录入室时(T0),超声识别坐骨神经时(T1),坐骨神经穿刺阻滞时(T2),喉罩全麻前(T3)几个时间点的平均动脉压(MAP)和心率(HR).结果 A组患者超声识别坐骨神经所用时间(46 ± 11. 5)s明显少于B组(56 ± 12. 6)s,两组比较差异有统计学意义(P＜0. 05).无法识别坐骨神经A组有1例,B组8例,两组比较差异有统计学意义(P＜0. 05).起效时间方面比较A组慢于B组,两组比较差异有统计学意义(P＜0. 05).阻滞持续时间方面比较A组短于B组,差异有统计学意义(P＜0. 05).坐骨神经阻滞中A组在T1,T2时间点MAP和HR明显低于B组,两组比较差异有统计学意义(P＜0. 05).两组患者在神经阻滞过程中未见神经损伤、穿刺部位血肿、麻药中毒等并发症.结论 大腿中下段旁外侧入路超声识别坐骨神经成功率高,坐骨神经阻滞操作时间短,患者平卧位,操作简便.神经阻滞过程中循环更稳定.虽然大腿中下段旁外侧入路阻滞起效时间相对较长,维持时间偏短,但是完全能够满足外科手术的麻醉需求.两种入路的麻醉效果及并发症无差异.%Objective To compare the clinical effect of sciatic nerve block guided by ultrasound between the lateral pa-raspinal approach of the middle and lower thigh and the classical Labat approach. Methods 120 patients received surgery for dis-tal lower extremity fracture in our hospital were selected and randomly divided into two groups: the lateral paraspinal approach of the middle and lower thigh group (group A) and classic Labat approach group ( group B),60 cases in each group. After femoral nerve block,patients in the two groups completed sciatic nerve block with different approaches. The condition of sciatic nerve iden-tified by ultrasound,the onset time after sciatic nerve block and the duration of sciatic nerve block were recorded. The mean arterial pressure(MAP) and heart rate (HR) at the time of admission (T0),ultrasound recognition of sciatic nerve (T1),sciatic nerve block (T2),and laryngeal mask before general anesthesia (T3) were recorded. Results The time of ultrasonic identification of sciatic nerve in group A was (46 ± 11. 5) s,significantly less than that in group B (56 ± 12. 6) s,and the difference between the two groups was statistically significant(P＜0. 05). 1 patient in group A could not identify the sciatic nerve,8 cases in group B (P＜0. 05),statistically significant(P＜0. 05). The onset time in group A was slower than that in group B,and the difference was statistically significant(P＜0. 05)The duration of block in group A was shorter than that in group B(P＜0. 05). In sciatic nerve block,MAP and HR in group A at T1 and T2 were significantly lower than those in group B(P＜0. 05). No nerve injury,hematoma at puncture site,drug poisoning and other complications were found in the two groups during nerve block. Conclusion The super-sonic identification of sciatic nerve by lateral paraspinal approach in the middle and lower thigh has high success rate,short opera- tion time of sciatic nerve block,supine position of the patient,and simple operation. Circulation is more stable during nerve block. Although the lateral paraspinal approach block in the middle and lower thigh has a relatively long onset time and short maintenance time,it can completely meet the anesthetic requirements of surgery. There is no difference in anesthetic effect and complications be-tween the two approaches.