协和医学杂志

2011, v.2(04) 326-330

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髋关节手术新型麻醉方式:腰丛、坐骨神经及椎旁神经联合阻滞
Application of Lumber Plexus,Sciatic Nerve,and Paravertebral Nerve Block for Hip Arthroplasty

阮侠;徐仲煌;
RUAN Xia,XU Zhong-huang Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的评估腰丛+坐骨神经联合椎旁神经阻滞在人工髋关节置换术中的应用价值。方法回顾性分析34例行人工髋关节置换手术的患者,根据不同麻醉方式分为全身麻醉组(GA组)、硬膜外组(EA组)和外周神经阻滞组(NB组),NB组进一步分为腰丛+坐骨神经阻滞组(LS组)和腰丛+坐骨神经+椎旁神经阻滞组(PVB),比较各组患者的围手术期情况。结果 NB组患者平均年龄和术前合并疾病发生率明显高于其他两组(P<0.05),NB组患者术中收缩压、舒张压和心率最大变化率分别为13.9%±6.1%、15.8%±8.2%和14.0%±4.7%,明显低于GA组的21.6%±7.0%、23.3%±7.2%和23.3%±7.8%(P<0.05)。NB组患者术中芬太尼使用量为(103.8±42.7)μg,显著低于GA组的(295.0±55.4)μg(P<0.05)。与LS组比较,PVB组患者收缩压和舒张压的最大变化率显著减低,分别为9.0%±3.4%vs.18.8%±3.3%和9.0%±4.1%vs.22.5%±4.2%(P<0.05);芬太尼用量减少,PVB组为(87.5±47.9)μg,LS组为(120.0±35.6)μg,但两组比较差异无统计学意义(P>0.05)。结论外周神经阻滞复合小剂量静脉麻醉可以安全有效地用于人工髋关节置换术,腰丛+坐骨神经复合椎旁神经阻滞可进一步增加外周神经阻滞的阻滞效果。
Objective To evaluate the value of lumber plexus + sciatic nerve + paravertebral nerve block as an anesthesia technique for hip arthroplasty surgery.Methods We retrospectively analyzed the peri-operative data of 34 patients scheduled for a hip arthroplasty surgery.According to the different anesthesia techniques applied,patients were divided into 3 groups:general anesthesia(GA) group,epidural anesthesia(EA) group,and nerve block(NB) group.Patients in NB group were further divided into lumber plexus+sciatic nerve block(LS) group and lumber plexus+sciatic nerve+paravertebral nerve block(PVB) group.Results The average age and the incidence of coexisting disease in NB group were significantly higher than those in GA and EA group(P<0.05).Significant decreases in the variation of systolic blood pressure,diastolic blood pressure and heart rate in NB group were observed compared with GA group(13.9%±6.1% vs.21.6%±7.0%,15.8%±8.2% vs.23.3%±7.2%,14.0%±4.7% vs.23.3%±7.8%,all P<0.05),and the intra-operative dosage of fentanyl was significantly lower [(103.8±42.7) μg vs.(295.0±55.4) μg,P<0.05].Compared with LS group,the variations of systolic blood pressure and diastolic blood pressure significantly reduced in PVB group(9.0%±3.4% vs.18.8%±3.3%;9.0%±4.1% vs.22.5%±4.2%,P<0.05),and the fentanyl consumption was lower but without a significant difference [(87.5±47.9) μg vs.(120.0±35.6) μg,P>0.05].Conclusions Peripheral nerve block combined with small-dose intravenous anesthesia is a safe and effective anesthetic technique for hip arthroplasty surgery,and lumbar plexus+sciatic nerve+paravertebral nerve block probably can be a more effective regional anesthetic technique.

关键词(KeyWords): 外周神经阻滞;椎旁神经阻滞;髋关节置换术
peripheral nerve block;paravertebral nerve block;hip arthroplasty

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作者(Author): 阮侠;徐仲煌;
RUAN Xia,XU Zhong-huang Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

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