腰丛-坐骨神经阻滞用于老年病人膝关节镜手术的临床观察

A clinical study on combined lumbar plexus-sciatic nerve block in elderly undergoing knee arthroscopy surgery

关键词:  腰丛－坐骨神经阻滞  罗哌卡因

Key words:  lumbar plexus block  sciatic nerve block  ropivacaine.

摘要:

［目的］ 观察比较1%利多卡因联合0.5%盐酸罗哌卡因用于老年人、青年人腰丛-坐骨神经阻滞行膝关节镜手术时的生命体征变化及麻醉效果异同。［方法］ASA-级择期膝关节镜手术病人按年龄分60岁以上为Ⅰ组（老年组，n=30）,年龄15~42岁为Ⅱ组（青年组，n=20）。1%利多卡因联合0.5%盐酸罗哌卡因行腰丛-坐骨神经阻滞,观察患者阻滞后心率、呼吸、血压、血氧饱和度有无改变及感觉神经阻滞起效时间、运动神经阻滞效果，麻醉效果，镇痛持续时间及运动阻滞持续时间。［结果］两组病人感觉和运动阻滞的起效时间、低血压、低氧血症发生率差别均无显著性意义；Ⅰ组病人的感觉阻滞持续时间为（14.79±6.78）h明显长于Ⅱ组的（8.54±4.42）h, P<0.01；Ⅰ组病人的运动阻滞持续时间为（10.25±4.38）h，明显长于Ⅱ组的（5.59±3.46）h，P<0.01。［结论］老年、青年病人都适用1%利多卡因联合0.5%盐酸罗哌卡因腰丛－坐骨神经阻滞行膝关节镜手术，老年病人感觉和运动阻滞时间较青年病人明显延长。

Abstract:

［Objective］To find out the different efficacy of 1%lidocaine and 0.5%ropivacain for lumbar plexus -sciatic nerve block between elderly and young patients.［Methods］Fifty patients ASA scheduled for knee arithroscopic surgery were divided into two groups, eldly group with 30 patients (above 60 years old)and young group with 20 patients(15 to 42 years old). Lumbar plexus combined sciatic nerve block was performed with the help of a nerve stimulator and 1%lidocaine combined with 0.5%ropivacain was administered in each group. To observe the change of every patients' HR.,R.,BP. and SpO2 and the blockade effect of sensory and motor nerve, the duration of analgesia and the patients’ degree of satisfaction were evaluated.［Results］There was no significant difference on the blockade effect, and there was no difference on the rate of side reaction between the two group, but a longer duration of sensory and motor blockade was found in eldly group than in young group.［Conclusions］1%Lidocaine combined with 0.5%ropivacain for lumbar plexus -sciatic nerve block under the help of a nerve stimulator are suitable for both elderly and young patients. A longer duration of sensory and motor blockade are found in eldly group than in young group.