三合一神经阻滞在高龄患者髌骨骨折术中的应用.docVIP

精品论文 参考文献 三合一神经阻滞在高龄患者髌骨骨折术中的应用 黄建斌 蒋润年 林石全 (福建医科大学附属闽东医院麻醉科 355000) 【摘 要】目的 探讨三合一神经(即股神经、股外侧皮神经、闭孔神经)阻滞麻醉用于高龄患者髌骨骨折手术的效果。方法 60 例行髌骨骨折手术患者随机均分为两组。I 组采用三合一神经阻滞麻醉，正确定位后注入0.33%左布比卡因+0.66%利多卡因30ml；II 组选择L3-4 间隙行硬膜外麻醉，给予0.33%左布比卡因+0.66%利多卡因10—15ml。 观察两组血流动力学变化，阻滞效果及其不良反应。结果 II 组麻醉20min 后各时点的BP 均明显低于麻醉其I 组(Plt;0.01)；II 组麻醉20min 后各时点的BP 均明显低于麻醉前 (Plt;0.01)；II 组术中使用麻黄碱例数高于I 组(Plt;0.01)；II 组患者围术期寒战、尿储留、腰背酸痛等不良反应的发生率明显高于I 组(Plt;0.01)。结论 三合一神经阻滞麻醉对血流 动力学影响小，麻醉效果可，并发症少，适用于高龄患者髌骨手术的麻醉。 [Abstract]: Objective three in one nerve (i.e. the femoral nerve，the lateral femoral cutaneous nerve，the obturator nerve) block anesthesia for elderly patients of patella fracture operation effect. Methods 60 cases of patellar fracture operation were randomly divided into two groups. Group I with three combined nerve block anesthesia，correct positioning after injection of 0.33% levobupivacaine +0.66% lidocaine 30ml; group II L3-4 clearance of epidural anesthesia，with 0.33% levobupivacaine +0.66% lidocaine of 10 - 15ml. To observe the hemodynamic changes in the two groups，anesthesia effect and adverse reaction. Results in group II，anesthesia 20min at each time point after BP were significantly lower than those of the I group of anesthesia (Plt;0.01); group II anesthesia 20min at each time point after BP were significantly lower than those before anesthesia (Plt;0.01); the number is higher than that of I group methamphetamine use cases of patients in group II (Plt;0.01); group II patients perioperative shivering，urine left，back pain and other adverse reactions were significantly higher than those in I group (Plt;0.01). Conclusion three in one nerve block anesthesia effects on hemodynamics，anesthesia effect，less complications，anesthesia is suitable for elderly patients withpatellar operation. 【关键词】高龄患者 髌骨骨折手术 三合一神经 高龄患者髌骨骨折手术临床上比较常见，往往合并基础疾病较多，如高血压病、 冠心病、慢性支气管炎、脊柱畸形等，以往通常采用椎管内麻醉完成手术，但椎管穿 刺困难，术中血流动力学不稳定及麻醉穿刺后造成的腰部酸痛和术毕尿储留限制了此 种麻醉方法在临床上的应用。三合一神经阻滞麻醉可取得髌骨手术区