【摘要】 目的:观察小儿下肢手术在神经刺激器引导下应用腰丛-坐骨神经联合阻滞的可行性。方法:25例择期行单侧下肢手术的患儿,入室后浅麻醉,患侧在上侧卧,通过髂后上棘作棘突连线的垂线,此线外1/4与内3/4交点做棘突连线的平行线,在平行线上髂骨边缘向头端1cm处为腰丛穿刺点;分别作股骨大转子与髂后上棘的连线(股髂线)和股骨大转子与骶裂孔的连线(股骶线),通过股髂线的中点作垂线,此线与股骶线的交点为坐骨神经穿刺点,在神经刺激器引导下分别行腰丛和坐骨神经阻滞。结果:25例患儿均成功诱导出相应的肌肉运动,均成功在浅全麻复合神经阻滞下完成手术,术后镇痛平均时间为(4.8±1.6)h,术中血压、心率和血氧饱和度均无显著变化,术后无尿潴留、呼吸抑制、躁动和呕吐等并发症。腰丛穿刺位置与患儿年龄和体重显著相关。结论:小儿腰丛和坐骨神经的穿刺位点在体表有固定的解剖关系,腰丛-坐骨神经联合阻滞麻醉效果好,可应用于小儿下肢手术。更多还原

【Abstract】 Objective:To observe the feasibility of combined lumbar plexus and sciatic nerve block guided by nerve stimulator in children for lower limb surgery. Methods:Children undergoing unilateral lower limb surgery were positioned in the lateral position with the operative side uppermost. A line from the posterior superior iliac spine (PSIS) perpendicular to the connecting line of the spinous processes (SP) was drawn. At the point of intersection of the medial 3/4 and the lateral 1/4 on this line, another line parallel to line of the SP was drawn. The point of needle insertion was 1 cm cephalad to the junction of the line and crista iliaca. A line was drawn from the greater trochanter to the posterior superior iliac spine. From the midpoint of this line, a second line was drawn perpendicu-larly and extended caudally. The junction of the second line and the line that from the greater trochanter to the sacral hiatus was the point of needle insertion. The direction of the needle was adjusted to maintain the good motor response with a stimulating current of 0.2～0.3 mA. Local anesthetic was injected. Results:All 25 patients were elicited successfully corresponding muscular twitches by nerve stimulator. All patients completed operation aid by nerve block with light general anesthesia. The mean time of postoperative analgesia was( 4.8±1.6)h,vital signs were stabilized during operation. No complication happened, including urinary retention, respiratory depression, restlessness and vomiting. The site of puncture of lumbar plexus was correlated to patient age (r=0.858) and weight (r=0.883) significantly (P<0.05). Conclusion: With good effect and few complication, combined lumbar plexus and sciatic nerve block can be a viable choice for lower limb surgery in children.更多还原