Li J, Ke X J, Liu Y, Chen K, Chen M B, Mei W
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Zhonghua Yi Xue Za Zhi. 2016 Nov 22;96(43):3470-3473. doi: 10.3760/cma.j.issn.0376-2491.2016.43.006.
To evaluate the clinical efficacy of lumbar plexus-the first posterior sacral foramina block as an anesthesia technique for hip arthroplasty in elderly patients. Forty-four patients, aged 60-91 years, weighing 37-100 kg, American Society of Anesthesiologists (ASA) Ⅰ-Ⅲ, underwent elective hip arthroplasty in Tongji Hospital from February 2015 to January 2016.All patients received lumbar plexus and the first posterior sacral foramina block.The first posterior sacral foramina puncture point of 23 cases were located by traditional positioning method, the others were orientated via ultrasonic method.Measurements included effect of sensory blockade after 30 min of completed injection, hemodynamic parameters, quality of surgery blockade, and postoperative adverse reactions related to nerve block. The success rates of the sensory blockade of pinprick for the dermatomes L1-S3 were from 73% to 100%, with 93% success rates of surgical analgesia.Compared with baseline (T) , the systolic blood pressure (SBP) decreased at 10 min after incision (T) and 20 min after incision (T) [T vs T: (137±23) mmHg vs (119±20) mmHg, =3.825, <0.05; T vs T: (137±23) mmHg vs (118±18) mmHg, =4.403, <0.05]. Heart rate (HR) and diastolic blood pressure (DBP) had no significant changes at different time points (=0.877, 1.439, >0.05). One patient suffered urinary incontinence. Lumbar plexus-the first posterior sacral foramina block is one of safe and effective anesthetic techniques for hip arthroplasty in aged patients.
评估腰丛-第一骶后孔阻滞作为老年患者髋关节置换术麻醉技术的临床疗效。2015年2月至2016年1月，44例年龄60-91岁、体重37-100kg、美国麻醉医师协会（ASA）分级Ⅰ-Ⅲ级的患者在同济医院接受择期髋关节置换术。所有患者均接受腰丛和第一骶后孔阻滞。23例患者的第一骶后孔穿刺点采用传统定位方法确定，其余患者通过超声方法定位。测量指标包括注射完成30分钟后的感觉阻滞效果、血流动力学参数、手术阻滞质量以及与神经阻滞相关的术后不良反应。L1-S3皮节针刺感觉阻滞成功率为73%至100%，手术镇痛成功率为93%。与基线（T0）相比，切开后10分钟（T1）和切开后20分钟（T2）收缩压（SBP）下降[T0 与 T1：(137±23)mmHg 与(119±20)mmHg，t =3.825，P<0.05；T0 与 T2：(137±23)mmHg 与(118±18)mmHg，t =4.403，P<0.05]。不同时间点心率（HR）和舒张压（DBP）无显著变化（F =0.877，1.439，P>0.05）。1例患者出现尿失禁。腰丛-第一骶后孔阻滞是老年患者髋关节置换术安全有效的麻醉技术之一。
