[1]李水清,王军,贾东林,等.外周神经阻滞在血管外科重症患者下肢手术中的应用[J].中国微创外科杂志,2008,08(3):232-234.
　Li Shuiqing,Wang Jun,Jia Donglin,et al.Peripheral Nerve Block during Lower Limb Procedures for Severe Patients with Vascular Diseases[J].Chinese Journal of Minimally Invasive Surgery,2008,08(3):232-234.
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外周神经阻滞在血管外科重症患者下肢手术中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
08
期数:
2008年3期
页码:
232-234
栏目:
出版日期:
2008-10-25

文章信息/Info

Title:
Peripheral Nerve Block during Lower Limb Procedures for Severe Patients with Vascular Diseases
作者:
李水清; 王军; 贾东林; 南兴东
北京大学第三医院麻醉科，北京100083
Author(s):
Li Shuiqing;  Wang Jun;  Jia Donglin;  et al.
Department of Anesthesiology, Peking University Third Hospital, Beijing 10083, China
关键词:
腰丛阻滞; 坐骨神经阻滞; 血管外科重症患者
Keywords:
Lumbar plexus block;  Sciatic nerve block;  Severe patients with vascular diseases
分类号:
R614.4
文献标志码:
A
摘要:
目的采用外周神经刺激器引导行腰丛联合坐骨神经阻滞，评价其在血管外科重症患者（ASA分级为Ⅲ、Ⅳ级）下肢手术中的临床应用价值。方法2006年4月~2007年5月，接受下肢外周神经阻滞的血管外科病人，根据ASA分级分为2组，Ⅰ、Ⅱ级为普通组（C组,n=22），作为对照，Ⅲ、Ⅳ级为重症组（S组,n=25）。2组都在神经刺激器引导下行腰丛联合坐骨神经阻滞，分析两组的麻醉效果，感觉和运动阻滞的起效时间，恢复时间，术中和术后并发症发生情况。结果组间比较，两组的麻醉效果无统计学差异（C组麻醉效果好15例，中4例，差3例；S组麻醉效果好18例，中5例，差2例；U=261000，P=0.710）。C组68.2%(15/22)的病例，S组72.0%(18/25)的病例都可以很好地满足外科手术对麻醉的要求。组间比较，2组的感觉运动阻滞起效时间无差异（P>0.1），S组腰丛、坐骨神经的感觉和运动恢复时间长于C组（P<0.01）。C组1例术中双侧阻滞，1例术后大腿前面感觉麻木；S组1例术后腹膜后血肿。这些患者经保守治疗均痊愈出院。结论血管外科下肢手术中，ASA分级为Ⅲ、Ⅳ级的重症患者应用外周神经阻滞，可以取得和普通患者同样的麻醉效果，能够满足手术的需要，一些对抗凝治疗敏感的病例，围术期要注意凝血功能的监测。
Abstract:
ObjectiveTo evaluate the value of peripheral nerve stimulatorguided lumbar plexus and sciatic block during lower limb procedures for severe patients with vascular diseases (ASA Ⅲ or Ⅳ).MethodsFrom April 2006 to May 2007, 47 patients with vascular diseases scheduled for lower limb procedures were divided into 2 groups according to their ASA grades: control (ASA Ⅰ or Ⅱ, C group, n=22) and severe groups (ASA Ⅲ or Ⅳ, S group, n=25). Peripheral nerve stimulatorguided lumbar plexus and sciatic block was performed on both the groups. The effect of nerve block, the effective time for sensory and motor block, time of recovery, and intra and postoperation complications in the two groups were compared. ResultsNo significant difference was found in the effect of nerve block between the two groups (C group: excellent in 15 cases, fair 4, and poor 3; S group: excellent 18, fair 5, and poor 2; U=261.000, P=0.710). The nerve block was effective for surgical treatment in 68.2% (15/22) of the patients in C group and 72.0% (18/25) in S group. The onset time of sensory and motor block was similar in both groups (P>0.1), but duration of sensory and motor block in S group was longer than that in C group (P<0.01). In C group, one patient had bilateral block during operation, and one had numbness in the thigh after operation. In S group, one patient developed retroperitoneal haematoma three days after operation. The patients with complications were cured and discharged from hospital after conservative treatments.ConclusionsPeripheral nerve block is effective during lower limb procedures for severe patients with ASA Ⅲ or Ⅳ grade vascular diseases. The anesthesia outcome in these patients is similar to that in nonsevere patients. For patients sensitive to anticoagulation therapy, blood coagulation monitoring is necessary during perioperative period.

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更新日期/Last Update: 2013-10-22