神经阻滞与轻比重麻醉在高龄患者单侧下肢创伤手术麻醉中的安全性与有效性比较

发布时间：2018-03-04 21:39

本文选题：下肢创伤手术　切入点：神经阻滞　出处：《医学综述》2016年17期 　论文类型：期刊论文

【摘要】：目的比较神经阻滞与轻比重麻醉在高龄患者单侧下肢创伤手术麻醉中的安全性和有效性。方法选取2011年5月至2014年4月来桂林医学院附属医院行下肢创伤手术的高龄(80岁)患者80例作为研究对象,按照随机数字表法分为研究组(41例)和对照组(39例)。研究组行腰丛或者坐骨神经阻滞麻醉,先给1%利多卡因10 m L,然后注入0.4%~0.5%罗哌卡因20 m L,每给5 m L药物回抽无血液再继续注入药液,直到全量;对照组行轻比重蛛网膜下腔麻醉,以1%罗哌卡因1 m L+无菌注射用水1 m L混合注入后继续侧卧10 min调节麻醉平面。记录两组患者注药前、注药后15 min、注药后30 min、注药后60 min、术毕时收缩压(SBP)、舒张压(DBP)、心率、脉搏血氧饱和度(Sp O2)变化和麻醉起效时间、阻滞完善时间及麻醉药用量,采用Bromage评分比较两组间麻醉效果。结果两组患者注药后15 min、30 min、60 min的SBP、DBP及心率呈下降趋势,术毕均恢复至注药前水平,差异均有统计学意义(P0.05);两组患者注药后15 min、30 min、60 min Sp O2水平呈上升趋势,术毕均恢复至注药前水平,差异均有统计学意义(P0.05)。研究组麻醉药用量多于对照组、麻醉起效时间、阻滞完善时间均显著长于对照组[(125.4±30.1)mg比(10.6±2.5)mg,(14.3±3.1)min比(7.0±2.5)min;(20±7)min比(12±5)min,P0.01];研究组术中低血压发生率显著低于对照组[4.88%(2/41)比28.21%(11/39)](P0.01)。结论与轻比重麻醉比较,神经阻滞麻醉对下肢高龄手术患者血流动力学影响较小,并发症较少,且效果显著,作用时间长,临床可以推广。
[Abstract]:Objective to compare the safety and efficacy of nerve block and light specific gravity anesthesia in unilateral lower extremity trauma surgery in elderly patients. Methods from May 2011 to April 2014, the patients undergoing lower extremity trauma surgery in affiliated Hospital of Guilin Medical College were selected. 80 patients aged 80 years old were selected as the subjects of the study. According to the method of random number table, the study group (n = 41) and the control group (n = 39) received lumbar plexus or sciatic nerve block anesthesia. 1% lidocaine (10 mL) was given first, and then 0. 4% ropivacaine (20 mL) was injected. Every 5 mL drug was given without blood and then continued to be injected until the whole dose, while the control group was anesthetized by subarachnoid subarachnoid anaesthesia with light specific gravity. 1% ropivacaine 1 mL aseptic injection water was mixed with 1 mL of water to adjust anesthesia level for 10 min. Before injection, 15 min after injection, 30 min after injection, 60 min after injection, SBP, DBP, heart rate were recorded at the end of operation. The changes of pulse oxygen saturation and the onset time of anesthesia, the time of block improvement and the dosage of anesthetic were compared by Bromage score. Results the results showed that SBP, DBP and heart rate of the two groups decreased 15 minutes 30 minutes and 60 min after injection. At the end of operation, the level of SPO _ 2 returned to the level before injection, and the difference was statistically significant (P < 0.05), the level of SPO _ 2 in the two groups showed an upward trend 15 minutes to 30 minutes after injection and returned to the pre-injection level at the end of the operation. The difference was statistically significant (P 0.05). The dosage of anesthetic in the study group was more than that in the control group. The duration of block improvement was significantly longer than that of the control group [125.4 卤30.1mg vs 10.6 卤2.5mg / min vs 7.0 卤2.5min 20 卤7min vs 12 卤5min P0.01], the incidence of hypotension in the study group was significantly lower than that in the control group [4.8820% / 41mg vs 28.21g / 1139] P 0.01.Conclusion compared with light specific gravity anesthesia, the incidence of hypotension in the study group was significantly lower than that in the control group [4.88 卤30.1 mg vs 10.6 卤2.5 mg / min vs 7.0 卤2.5 min, 20 卤7 min vs 12 卤5 min P0.01]. Nerve block anesthesia has little effect on hemodynamics, fewer complications, longer time and can be popularized in clinic.
【作者单位】：桂林医学院附属医院麻醉科;
【分类号】：R614.4

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