超声引导下神经阻滞在基层医院的推广应用

武旖旎　　王发兴　　代虹　　韩新　　吴继敏　　徐巧敏　　李中华

[关键词] 超声引导;神经阻滞;基层医院;推广应用

[中图分类号] R614.4          [文献标识码] B          [文章编号] 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储备功能下降，围术期麻醉风险高[1]。基层医院收治的老年下肢骨折患者多采用椎管内麻醉或全身麻醉，呼吸循环系统抑制明显。外周神经阻滞具有操作简单、效果确切、对生理干扰小等优点，近年来逐渐用于老年患者的麻醉[2-3]。而超声可视化技术的应用大大提高了神经阻滞成功率并减少并发症的发生[4-5]。但基层医院医疗条件相对较差，神经阻滞仍以经验和盲探为主，严重影响临床麻醉的准确性和安全性。本研究将超声引导下神經阻滞技术推广至基层医院，探讨其作用效果，为基层医院患者麻醉方案的选择提供新思路，现报道如下。