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上海市卫生健康委员会
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超声引导腰丛阻滞在全髋置换术中的应用：平面内对平面外技术

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DOI:
作者:
郑萍,赵达强,王爱忠,江伟
ZHENG Ping, ZHAO Daqiang, WANG Aizhong，JIANG Wei
作者单位:
上海交通大学附属第六人民医院
Shanghai Sixth People’s Hospital, Shanghai Jiaotong University
关键词:
超声；腰丛；全髋关节置换术；平面内；平面外
Ultrasound;lumbar plexus;total hip replacement;in-plane;out-of-plane
摘要:
目的 比较长轴平面外技术和短轴平面内技术在超声引导腰丛神经阻滞中的应用。方法 选择ASA I～III级择期行全髋置换术患者150例，年龄24～86岁，随机分为两组，每组75例，在超声引导下分别采用短轴平面内(A组)和长轴平面外(B组)技术进行腰丛神经阻滞。记录图像定位时间和穿刺时间；测试股神经、股外侧皮神经、闭孔神经和坐骨神经的感觉阻滞程度；评估膝关节运动阻滞程度。观察患者是否发生双侧阻滞。 结果 两组股神经、股外侧皮神经、闭孔神经阻滞的成功率都无显著性差异（96% 对94.67%，P=0.699；89.3% 对90.7%，P=0.785；80.0% 对81.3%，P=0.836）。B组的图像定位时间短于A组（39.20±25.79秒 对29.20±14.47秒）（P=0.001）。两组双侧阻滞的发生率无显著性差异（2.67% 对9.30%，P=0.086）。结论 这两种超声引导技术都能获得良好的腰丛阻滞效果，但长轴平面外技术比短轴平面内技术更容易获得目标图像。
Objective To compare out-of-plane technology with ultrasound probe parallel to spinal column with in-plane technology with probe perpendicular to spinal column in ultrasound-guided lumbar plexus block. Methods One hundred and fifty patients aged 24－86 years undergoing total hip replacement were randomized into 2 groups (n=75 each) to receive lumbar plexus block with longitudinal scan vertical scan in-plane technology (A group) or vertical scan out-of-plane technology (B group) . We recordes the figure identified time and puncture time.Sensory block uses cold and pinprick tests in the femoral, obturator, lateral femoral cutaneous and sciatic nerve distributions 30 minutes after Anesthesia. Modified knee motion score was used to assess knee movement of motor block. Thirty milliliter 0.5% ropivacaine was injected in psoas muscle gap at level of L3-4.The successful rate ,the performing time, the occurrence of bilateral block,and the sensory recovery time were recorded. Results The successful rate of the femoral, lateral femoral cutaneous and obturator nerve was no significantly different in A and B group（96% versus 94.67%，P=0.699；89.3% versus 90.7%，P=0.785；80.0% versus 81.3%，P=0.836）.Image acquisition time was shorter in group B than in group A（39.20±25.79 s Vs 29.20±14.47 s）（P=0.001）.There was no different in the occurrence of bilateral block between two group（A group:2.67% Vs B group:9.30%）（P=0.086）. Conclusion The two methods both can provide good blocking of lumbar plexus nerve,but it is easier to acquisit image with out-of-plane technology than with in-plane technology.

 

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