神经刺激仪定位下腰丛联合坐骨神经阻滞对下肢手术患者血液动力学及应激反应的影响

目的:探讨神经刺激仪定位下腰丛联合坐骨神经阻滞对下肢手术患者血液动力学、应激反应的影响。方法:选取福建医科大学附属南平第一医院2014年1月-2015年6月收治的单侧下肢手术患者60例,依据不同的麻醉方法分为对照组(n=29)和研究组(n=31),对照组给予硬膜外麻醉,研究组于神经刺激仪定位下行腰丛联合坐骨神经阻滞,对比两组患者的麻醉效果,同时对比患者在麻醉前(T0)、麻醉后5 min(T1)、麻醉后15 min(T2)、麻醉后30 min(T3)、术毕(T4)时的血液动力学指标以及术前(Ta)、术中(Tb)、术毕(Tc)时的应激反应情况,并对比两组不良反应发生情况。结果:研究组优良率为96.77%,与对照组的93.10%对比差异无统计学意义(P0.05)。研究组T1、T2、T3、T4时平均动脉压(MAP)、心率(HR)与T0时比较,差异无统计学意义(P0.05),对照组T2、T3时MAP低于T0时,T1、T2、T3、T4时HR低于T0时,且均低于研究组,差异有统计学意义(P0.05)。Ta、Tc时,两组血糖(GLU)、皮质醇(Cor)、儿茶氨酚(CA)水平比较差异无统计学意义(P0.05),Tb时两组GLU、Cor、CA水平高于Ta时,但研究组低于对照组,差异有统计学意义(P0.05)。研究组不良反应发生率为6.45%,低于对照组的24.14%,差异有统计学意义(P0.05)。结论:神经刺激仪定位下腰丛联合坐骨神经阻滞应用于下肢手术患者效果较好,患者血液动力学稳定,且应激反应轻,不良反应少。

Effect of Lumbar Plexus Combined with Sciatic Nerve Block on Hemodynamics and Stress Response in Patients with Lower Extremity Surgery by Nerve Stimulator

ABSTRACT Objective: To investigate the effect of lumbar plexus combined with sciatic nerve block on hemodynamics and stress response in patients with lower extremity surgery by nerve stimulator. Methods: Medical University from January 2014 to June 2015, were selected and were divided into control group (n=29) and study group (n=31) according to different anesthetic methods. The control group was given epidural anesthesia, and the study group was given lumbar plexus combined with sciatic nerve block by the nerve stimulator. The anesthetic effect of patients in the two groups was compared, meanwhile, the hemodynamic indexes of patients before anesthesia (T0), 5 min after anesthesia (T1), 15min after anesthesia (T2), 30 min after anesthesia (T3) and at the end of operation (T4) were compared; the stress reaction before operation (Ta), intraoperative (Tb) and postoperative (Tc) were compared; the occurrence of adverse reactions in the two groups were compared. Results: The excellent rate of the study group was 96.77%, and there was no significant difference compared with 93.10% of the control group (P>0.05). The difference of mean arterial pressure (MAP) and heart rate (HR) at T1, T2, T3 and T4 in the study group was not statistically significant compared with T0 (P>0.05). MAP at T2 and T3 of the control group was lower than T0, HR at T1, T2, T3 and T4 was lower than T0, which were lower than that of the study group, and the difference was statistically significant (P<0.05). There were no significant differences in the levels of blood glucose (GLU), cortisol (Cor) and catechin (CA) between the two groups at Ta, Tc (P>0.05). At Tb, the levels of GLU, Cor and CA in the two groups were higher than those at Ta, but the study group was lower than the control group, and the difference was statistically significant (P<0.05). The incidence of adverse reactions of the study group was 6.45%, which was lower than that of the control group (24.14%), and the difference was statistically significant (P<0.05). Conclusion: The effect of lumbar plexus combined with sciatic nerve block by nerve stimulator in the treatment of the patients with lower extremity surgery is better, and the patient has a stable hemodynamics,mild stress response and less adverse reactions.