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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

阮侠 徐仲煌

阮侠, 徐仲煌. 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[J]. 协和医学杂志, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009
引用本文: 阮侠, 徐仲煌. 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[J]. 协和医学杂志, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009
Xia RUAN, Zhong-huang XU. Application of Lumber Plexus, Sciatic Nerve, and Paravertebral Nerve Block for Hip Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009
Citation: Xia RUAN, Zhong-huang XU. Application of Lumber Plexus, Sciatic Nerve, and Paravertebral Nerve Block for Hip Arthroplasty[J]. Medical Journal of Peking Union Medical College Hospital, 2011, 2(4): 326-330. doi: 10.3969/j.issn.1674-9081.2011.04.009

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

doi: 10.3969/j.issn.1674-9081.2011.04.009
详细信息
    通讯作者:

    徐仲煌 电话:010-65295580, E-mail:zhonghuangxu@yahoo.com.cn

  • 中图分类号: R614.4;R687.4

Application of Lumber Plexus, Sciatic Nerve, and Paravertebral Nerve Block for Hip Arthroplasty

More Information
  • 摘要:   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。
  • 表  1  三组患者一般资料

    组别 n 年龄(岁) 性别(男/女) ASA分级(1 /2 /3 /4) 手术时间(min)
    GA 16 61. 8 ± 16. 6 5 /11 1 /12 /3 /0 117 ± 27
    EA 10 58. 0 ± 11. 3 7 /3 3 /7 /0 /0 115 ± 37
    NB 8 75. 1 ± 11. 5* 3 /5 0 /5 /2 /1 93 ± 24
    ASA:美国麻醉医师协会; GA:全身麻醉; EA:连续硬膜外麻醉; NB:外周神经阻滞与GA及EA组比较,* P<0. 05
    下载: 导出CSV

    表  2  三组患者术中血流动力学变化

    组别 麻醉前即刻   切皮时   最大变化率
    SBP (mm Hg) DBP (mm Hg) HR (bpm)   SBP (mm Hg) DBP (mm Hg) HR (bpm)   SBP (%) DBP (%) HR (%)
    GA 132. 2 ± 17. 1 79. 1 ± 11. 1 73. 9 ± 8. 7   114. 1 ± 10. 0 68. 1 ± 7. 9 68. 4 ± 7. 0   21. 6 ± 7. 0 23. 3 ± 7. 2 23. 3 ± 7. 8
    EA 133. 0 ± 11. 1 82. 0 ± 7. 9 79. 4 ± 7. 2   120. 5 ± 6. 9 75. 5 ± 7. 6 72. 6 ± 11. 9   16. 1 ± 7. 1 25. 3 ± 9. 4 18. 2 ± 5. 2
    NB 138. 8 ± 24. 2 74. 4 ± 16. 8 80. 6 ± 6. 9   122. 5 ± 19. 8 68. 8 ± 14. 3 76. 5 ± 9. 9   13. 9 ± 6. 1* 15. 8 ± 8. 2* † 14. 0 ± 4. 7*
    GA,EA,NB:同表 1; SBP:收缩压; DBP:舒张压; HR:心率与GA组比较,* P<0. 05;与EA组比较,†P<0. 05
    下载: 导出CSV
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    [2] 徐仲煌, 唐帅, 罗爱伦, 等.腰丛神经阻滞在高龄患者髋关节手术中的应用[J].中国医学科学院学报, 2010, 32:328-331. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgyxkxyxb201003019
    [3] Pagnano MW, Hebl J, Horlocker T. Assuring a painless total hip arthroplasty:a Multimodal approach emphasizing peripheral nerve blocks[J]. J Arthroplasty, 2006, 21(4 Suppl 1):80-84. http://www.europepmc.org/abstract/MED/16781436
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    [8] de Leeuw MA, Slagt C, Hoeksema M, et al. Hemodynamic changes during a combined psoas compartment-sciatic nerve block for elective orthopedic surgery[J]. Anesth Analg, 2011, 112:719-724. doi:  10.1213/ANE.0b013e318206bc30
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    [10] Duarte LT, Paes FC, Fernandes MC, et al. Posterior lumbar plexus block in postoperative analgesia for total hip arthroplasty:a comparative study between 0.5% Bupivacaine with Epinephrine and 0.5% Ropivacaine[J]. Rev Bras Anestesiol, 2009, 59:273-285. doi:  10.1590/S0034-70942009000300002
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出版历程
  • 收稿日期:  2011-08-09
  • 刊出日期:  2011-10-30

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