超声引导下腰丛坐骨神经阻滞与腰硬联合麻醉在老年骨科PFNA手术中比较研究.docVIP

超声引导下腰丛坐骨神经阻滞与腰硬联合麻醉在老年骨科PFNA手术中比较研究 　　[摘要] 目的 探讨超声引导下腰丛坐骨神经阻滞在老年骨科PFNA手术中的效果。方法 选择老年骨科PFNA手术患者38例，根据麻醉方式分为A组（采用超声引导下腰丛坐骨神经阻滞）20例，B组（采用腰硬联合麻醉）18例。比较两组术前、阻滞后5min、10min、20min、30min、术毕时的收缩压（SBP）、舒张压（DBP）、心率（HR）变化情况及起效和维持时间。结果 A组SBP、DBP、HR术前、阻滞后各时间点无明显变化（P＞0.05）；B组在阻滞后5min开始SBP、DBP明显降低（P＜0.05），HR在各时间点无明显变化（P＞0.05）；两组患者术前SBP、DBP、HR无明显差异（P＞0.05）；但B组SBP、DBP在阻滞后5min、10 min、20min、30min、术毕min明显低于A组（P＜0.05）。A组起效时间晚于B组，维持时间长于B组（P＜0.05）。A组不良反应少于B组（P＜0.05）。 结论 超声引导下腰丛神经阻滞能提供较准确的穿刺位置，对患者机体血流动力学影响小，麻醉效果确切，术后不良反应少，对老年骨科PFNA术患者尤为适用。 　　[关键词] 超声；腰丛坐骨神经阻滞；腰硬联合麻醉；PFNA手术 　　[中图分类号] R614[文献标识码] B[文章编号] 1673-9701（2014）19-0058-04 　　 　　Comparative study of treating elderly orthopedics disease with PFNA operation between ultrasound guided lumbar plexus sciatic nerve block and epidural anesthesia 　　DUAN Haiping ZHANG Weiyi ZHENG Xinhua HA Siyuan FU Jun ZHOU Bo 　　Department of Anesthesiology，Traditional Chinese Medicine Hospital of Wuhan City，Hubei，Wuhan430014，China 　　[Abstract] Objective To investigate theeffect of treating elderly orthopedics disease with PFNA operationbetween ultrasound guided lumbar plexus sciatic nerve block and epidural anesthesia. Methods All 38 elderly patients with orthopedics disease who were treated with PFNA operation were selected， according to anesthesia mode，they were divided into group A and group B，group A in which therewere 20 cases were carried out ultrasound guided lumbar plexus sciatic nerve block， group B in which there were 18 cases were carried out epidural anesthesia. The systolic pressure（SBP）， diastolic pressure（DBP）， heart rate（HR） changes before operation，at 5， 10， 20， 30 minutes after anesthesiablock， after operation andthe onset time，duration time in two groups were compared. Results TheSBP， DBP， HR were no significant changes before operation and at every time point after anesthesia ingroup A （P＞0.05）；theDBP， SBP decreased significantly at 5 minutes after anesthesia in group B（P＜0.05）， the HR at every time point were no significant changes