论文部分内容阅读
目的比较腰丛-髂腹股沟-坐骨神经联合阻滞和单侧蛛网膜下腔阻滞对单侧大隐静脉曲张激光腔内闭合手术麻醉效果、血液动力学的影响及术后的不良反应的观察。方法选择60例临床拟行单侧大隐静脉曲张激光腔内闭合手术的患者，随机分为腰丛-髂腹股沟-坐骨神经联合阻滞组(N组，n=30)和单侧蛛网膜下腔阻滞(E组,n=30)两组，分别施行腰丛-髂腹股沟-坐骨神经联合阻滞和单侧蛛网膜下腔阻滞麻醉。 N组腰丛-髂腹股沟-坐骨神经联合阻滞采用神经刺激器定位技术，腰丛给予0.25%罗哌卡因+0.5%利多卡因合剂30ML,髂腹股沟神经给予0.25%罗哌卡因+0.5%利多卡因合剂5ml，坐骨神经给予0.25%罗哌卡因+0.5%利多卡因合剂15ML；E组则选择L2-3或L3-4间隙行单侧蛛网膜下腔阻滞，给予0.5%布比卡因8~12mg。记录两组麻醉效果及麻醉前、麻醉后15,30,60,90 min平均动脉压(MNP)和心率(HR)，升压药的用量及术后情况比较。结果与麻醉前比较，E组患者在麻醉后15 min,30 min的平均动脉压(MAP)明显低于N组(<0.05)，用麻黄碱的患者E组(17例)显著多于N组(2例)(<0.05), E组尿储留、头痛、恶心呕吐显著高于N组(<0.05)。结论应用神经刺激器定位技术下行腰丛-髂腹股沟-坐骨神经联合阻滞时麻醉效果满意，血流动力学影响小，不良反应少，是单侧大隐静脉曲张激光腔内闭合手术理想的麻醉选择。“,”Objective To compare the anesthesia ef ect, the ef ect of blood dynamics and postoperative adverse reactions between the lumbar plexus - iliac groin - sciatic nerve block and unilateral subarachnoid block in great saphenous varicose veins laser cavity closed surgery. Methods 60 cases of clinical great saphenous varicose veins laser cavity closed surgery patients were randomly divided into lumbar plexus-iliac groin -sciatic nerve block group (group A, n =30) and unilateral subarachnoid block group (group B, n =30), Group A:block the nerve with stimulator location technology, lumbar plexus to give 0.25% ropivacaine + 0.5% lidocaine mixture 30 ml, iliac inguinal nerves to give 0.25% ropivacaine + 0.5% lidocaine mixture 5 ml, sciatic nerve to give 0.25%ropivacaine+0.5%lidocaine mixture 15 ml;Group B:chose L2-3 or L3-4 gap to do unilateral subarachnoid block, using 0.5%bupivacaine 8 to 12 mg. Record the anesthesia ef ect ,before anesthesia and after anesthesia, 15, 30, 60, 90 min mean arterial pressure (MAP) and heart rate (HR), vasopressors using dosage and postoperative situation. Results Mean arterial pressure (MAP) after anesthesia 15 min, 30 min was lower in group B than that in group A ( < 0.05), patients using the ephedrine in group B (23 cases) was significantly more than that in group A (2 cases) ( < 0.05), urine retention, headache, nausea and vomiting in group B was significantly higher than that in group A ( < 0.05). Conclusion The way of lumbar plexus - iliac groin - sciatic nerve block with application of nerve stimulator location technology has satisfied anesthesia ef ect, smal hemodynamic ef ect, less adverse reaction, is one of ideal anesthesia choice in great saphenous varicose veins laser cavity closed surgery.