标题：超声联合神经刺激仪定位腰丛-坐骨神经阻滞在危重患者下肢手术中的应用

      作者：农兰依，谢林碧，王敏，彭丹丹，钟爱群，黄晓媚    佛山市高明区人民医院麻醉科，广东 佛山 528500

      卷次： 2019年30卷10期

      【摘要】 目的 观察超声联合神经刺激仪定位腰丛-坐骨神经阻滞在危重患者下肢手术中的临床应用效果。方法 将佛山市高明区人民医院2017年1月至2018年12月间120例拟行下肢手术的危重患者根据随机数表法分为三组，每组40例。A组采用神经刺激仪定位行腰丛-坐骨神经阻滞，B组采用超声定位行腰丛-坐骨神经阻滞，C组采用超声联合神经刺激仪定位行腰丛-坐骨神经阻滞。比较三组患者神经阻滞过程中血流动力学指标[收缩压(SBP)、舒张压(DBP)、心率(HR)]的变化，以及三组患者神经阻滞用时、起效时间、维持时间和并发症的差异。结果 三组患者神经阻滞过程中SBP、DBP、HR变化比较差异均无统计学意义(P>0.05)；C组患者的阻滞完成时间、阻滞起效时间分别为(10.24±1.03) min、(39.52±2.05) min，明显短于B组[(15.32±2.05) min、(46.25±3.95) min]和A组[(19.25±3.58) min、(42.52±2.85) min]，阻滞持续时间为(789.56±35.26) min，明显长于B组的(682.15±26.59) min和A组的(708.52±29.51) min，差异均有统计学意义(P<0.05)；A、B、C三组患者术中麻醉相关并发症发生率分别为10.0%、10.0%、7.5%，差异无统计学意义(P>0.05)。结论 超声联合神经刺激仪定位腰丛-坐骨神经阻滞可减少危重患者下肢神经阻滞起效时间，延长维持时间，提高阻滞效果，且对血流动力学影响小，不增加并发症风险。
      【关键词】 超声；神经刺激仪定位；危重患者；下肢手术；腰丛-坐骨神经阻滞
      【中图分类号】 R658.3 【文献标识码】 A 【文章编号】 1003—6350（2019）10—1303—04

Application value of ultrasound combined with nerve stimulator in lumbar plexus-sciatic nerve block in criticalpatients undergoing lower extremity surgery.
NONG Lan-yi, XIE Lin-bi, WANG Min, PENG Dan-dan, ZHONGAi-qun, HUANG Xiao-mei. Department of Anesthesiology, Gaoming District People's Hospital, Foshan 528500, Guangdong,CHINA
【Abstract】 Objective To explore the application value of ultrasound combined with nerve stimulator in lum-bar plexus-sciatic nerve block in critical patients undergoing lower extremity surgery. Methods A total of 120 criticallyill patients scheduled for lower limb surgery in Gaoming District People's Hospital from Jan. 2017 to Dec. 2018 were di-vided into three groups according to random number table, with 40 in each group. In group A, lumbar plexus-sciaticnerve block was performed by nerve stimulator localization; in group B, lumbar plexus-sciatic nerve block was per-formed by ultrasound localization; in group C, lumbar plexus-sciatic nerve block was performed by ultrasound combinedwith nerve stimulator localization. The changes of hemodynamic parameters (systolic blood pressure [SBP], diastolicblood pressure [DBP] and heart rate [HR] during nerve block were compared among the three groups, and the differenc-es of the time of nerve block, onset time, maintenance time and complications among the three groups were compared.Results There was no significant difference in the changes of SBP, DBP and HR during nerve block between the threegroups (P>0.05). The completion time and onset time of blockade in group C were (10.24±1.03) min, (39.52±2.05) min,respectively, which were significantly shorter than corresponding (15.32±2.05) min and (46.25±3.95) min in group Band corresponding (19.25±3.58) min and (42.52±2.85) min in group A (P<0.05). The duration of blockade was (789.56±35.26) min, which was significantly longer than (682.15±26.59) min in group B and (708.52±29.51) min in group A (P<0.05). There was no significant difference in the incidence of anesthesia-related complications among the three groups(10.0%, 10.0%, 7.5%; P>0.05). Conclusion Ultrasound combined with nerve stimulator localization can reduce the on-set time of nerve block, prolong the maintenance time, improve the blocking effect, and have little effect on hemodynam-ics, without increasing the risk of complications.
      【Key words】 Ultrasound; Localization of nerve stimulator; Critical patients; Lower limb surgery; Lumbar plex-us-sciatic nerve block