摘要
目的通过与人工触诊法和旁矢状位法比较,评价髂嵴消失定位法用于超声引导后路腰丛神经阻滞的效果。方法行超声引导下后路腰丛联合骶旁坐骨神经阻滞的下肢手术患者75例,年龄25~64岁,体重42~90kg,BMI 17~32kg/cm^2,ASA分级Ⅰ-Ⅲ级。采用随机数字表法,将其分为3组(n=25):人工触诊法组(M组)、旁矢状位法组(s组)和髂嵴消失定位法组(0组),分别在相应定位方法下进行平面内后路腰丛神经阻滞。注药后30min时记录各平面阻滞成功情况。记录确定腰椎间隙时间、腰丛神经阻滞穿刺时间、术中辅助用药情况、阻滞效果、穿刺和神经阻滞相关并发症的发生情况。结果与M组比较,O组和S组L1、L2平面阻滞成功率升高,L4、L5平面阻滞成功率降低(P<0.05),L3平面阻滞成功率差异无统计学意义(P>0.05),确定腰椎间隙时间延长,术中辅助用药率降低,O组阻滞效果增强(P<0.05)。与S组比较,O组L1、L2平面阻滞成功率升高,L4平面阻滞成功率降低,确定腰椎间隙时间缩短(P<0.05),阻滞效果差异无统计学意义(P>0.05)。3组腰丛神经阻滞穿刺时间比较差异无统计学意义(P>0.05)。3组均未见穿刺和神经阻滞相关并发症发生。结论与人工触诊法和旁矢状位法比较,髂骨消失定位法下行腰丛神经阻滞成功率更高,效果更好。
Objective To evaluate the efficacy of "over iliac crest method"for ultrasound-guided posterior lumbar plexus block by comparing with manual palpation and sagittal positioning.Methods A total of 75patients,aged 25-64yr,weighing 42-90kg,with body mass index of 17-32kg/cm^2,of A- merican Society of Anesthesiologists physical status Ⅰ -Ⅲ,scheduled for elective lower extremity surgery under ultrasound-guided posterior lumbar plexus block combined with parasacral sciatic nerve block,were divided into 3groups (n=25each)using a random number table method:manual palpation group (group M),sagittal positioning group (group S)and "over iliac crest method"group (group O).Patients received ultrasound-guided posterior lumbar plexus block with in-plane technique using the corresponding positioning method in M,S and Ogroups.Successful blockade of each level was recorded at 30min after in-jection.Time to determine the lumbar intervertebral space,puncture time for lumbar plexus block,the requirement for adjuvant drugs and block efficacy were recorded.The development of complications related to puncture and nerve block was also recorded.Results Compared with group M,the success rates of blockade at levels L1and L2were significantly increased,the success rates of blockade at levels L4and L5were decreased (P<0.05),no significant difference was found in the success rate of blockade at level L3(P> 0.05),the time to determine the lumbar intervertebral space was prolonged,and the requirement for adju- vant drugs was decreased during surgery in O and S groups,and the efficacy of block was significantly enhanced in group O(P<0.05).Compared with group S,the success rates of blockade at levels L1and L2 were significantly increased,the success rates of blockade at level L4were decreased,the time to determine the lumbar intervertebral space was shortened (P<0.05),and no significant change was found in the efficacy of block in group O(P>0.05).There was no significant difference in the puncture time for lumbar plexus block between the three g
作者
陈堃
李继
柯希建
吴茜
李文钧
梅伟
田玉科
Chen Kun;Li Ji;Ke Xifian;Wu Xi;Li Wenjun;Mei Wei;Tian Yuke(Department of Anesthesiology,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Anesthesiology,The First People's Hospital of Xining,Xining 810001,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2018年第6期699-702,共4页
Chinese Journal of Anesthesiology
基金
湖北省卫生计生委青年人才项目(WJ2015Q008)
华中科技大学同济医学院研究型临床医师资助计划.
