超聲引導下神經阻滯在基層醫(yī)院的推廣應用

武旖旎　　王發(fā)興　　代虹　　韓新　　吳繼敏　　徐巧敏　　李中華

[關鍵詞] 超聲引導;神經阻滯;基層醫(yī)院;推廣應用

[中圖分類號] R614.4? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）21-0103-04

Popularization and application of ultrasound-guided nerve block in primary hospitals

WU Yini? ?WANG Faxing? ?DAI Hong? ?HAN Xin? ?WU Jimin? ?XU Qiaomin? ?LI Zhonghua

Department of Anesthesiology，the Sixth Affiliated Hospital of Wenzhou Medical University， Lishui People′s Hospital，Lishui? 323000， China

[Abstract] Objective To explore the popularization and application effect of ultrasound-guided nerve block in primary hospitals. Methods A combination of theoretical knowledge training and on-site guidance was used to promote and apply ultrasound-guided nerve block to 6 county-level hospitals in Lishui City from June 2018 to December 2019. At the same time， 80 patients with femoral neck fractures from 6 county-level hospitals were selected and randomLy divided into the experimental group and the control group by random number table method. The experimental group was guided by ultrasound to locate the lumbar plexus and sciatic nerve and injected with 0.33% ropivacaine hydrochloride+0.5% lidocaine 30 mL.The control group was treated with combined spinal-epidural anesthesia，and 2 mL 0.5% ropivacaine hydrochloride was injected into the subarachnoid cavity. The onset and maintenance time of anesthesia， anesthesia effect，and vital signs changes of the two groups were compared. Results The pass rate of anesthesiologists' knowledge of nerve block under ultrasound guidance increased significantly after training （P<0.05）. Compared with control group， the nset and maintenance time of the experimental group were prolonged（P<0.05），and hemodynamics of lumbar plexus-sciatic nerve block after anesthesia were more stable（P<0.05）. There was no statistical difference in the anesthesia effect between the two groups. Conclusion The promotion of ultrasound-guided nerve block suitable technology in primary hospitals has greatly improved the clinical skills of primary anesthesiologists， reduced the risk of perioperative anesthesia for elderly fracture patients， and enabled more patients to receive safe diagnosis and treatment in primary hospitals.

[Key words] Ultrasound guidance; Nerve block; Primary hospitals; Promotion and application

老年患者心肺等器官儲備功能下降，圍術期麻醉風險高[1]。基層醫(yī)院收治的老年下肢骨折患者多采用椎管內麻醉或全身麻醉，呼吸循環(huán)系統(tǒng)抑制明顯。外周神經阻滯具有操作簡單、效果確切、對生理干擾小等優(yōu)點，近年來逐漸用于老年患者的麻醉[2-3]。而超聲可視化技術的應用大大提高了神經阻滯成功率并減少并發(fā)癥的發(fā)生[4-5]。但基層醫(yī)院醫(yī)療條件相對較差，神經阻滯仍以經驗和盲探為主，嚴重影響臨床麻醉的準確性和安全性。本研究將超聲引導下神經阻滯技術推廣至基層醫(yī)院，探討其作用效果，為基層醫(yī)院患者麻醉方案的選擇提供新思路，現(xiàn)報道如下。