不同背景量连续胫神经阻滞用于跟骨手术术后镇痛的临床效果  

Postoperative analgesia effect of different background volumes of ropivacaine in continuous tibial nerve block in patients with calcaneal surgery

作　　者：伊军[1] 许莉[1] 林惠华[1] 

机构地区：[1]北京积水潭医院麻醉科,北京100035

出　　处：《北京大学学报（医学版）》2016年第2期283-286,共4页Journal of Peking University:Health Sciences

摘　　要：目的:观察不同背景量的连续胫神经阻滞用于跟骨手术术后镇痛的临床效果。方法:采用前瞻性随机、对照研究。选择60例ASAⅠ或Ⅱ级择期行跟骨手术患者,随机分为两组,每组30例,采用超声引导技术行腘窝后入路连续胫神经阻滞,定位成功后置入连续刺激导管,持续输注0.2%(质量分数)罗哌卡因,A组背景量为5 m L/h,B组背景量为3.2 m L/h。置管后第12、24、48小时记录患者视觉模拟评分法(visual analogue scale,VAS)评分、胫神经和腓总神经支配区域感觉阻滞情况与运动阻滞情况,并记录患者满意度评分。结果:VAS评分在第12、24和48小时3个时间点上两组患者比较,差异均无统计学意义(P>0.05)。两组患者48 h内胫神经感觉阻滞和胫神经运动阻滞情况比较,差异无统计学意义(P>0.05);两组患者48 h内腓总神经感觉阻滞和腓总神经运动阻滞情况比较,A组高于B组,差异有统计学意义(P<0.05);两组患者48 h内满意度评分比较,差异无统计学意义(P>0.05)。结论:使用3.2 m L/h背景量的0.2%(质量分数)罗哌卡因连续胫神经阻滞可为跟骨手术提供良好镇痛,同时可降低腓总神经感觉和运动阻滞的发生率。Objective： To observe the clinical effect of different background volumes of ropivacaine in continuous tibial nerve block of postoperative analgesia after calcaneal surgery. Methods： This study was a prospective,randomized,controlled study. Sixty cases of calcaneal visual analogue scale（ ASA） ⅠorⅡ undergoing elective surgery were selected and randomly assigned to two groups,thirty cases in each group. The patients received popliteal fossa posterior tibial nerve block using ultrasound guided. The continuous stimulation catheter was inserted after successful position and the 0. 2% ropivacaine was injected.The background volumes of the A and B groups were 5 mL / h and 3. 2 mL / h. The VAS score,the sensory block and motor block of tibial nerve and common peroneal nerve,and the satisfaction of the patients at h 12,h 24 and h 48 were recorded after catheter insertion. Results： The VAS scores at the three time points（ h 12,h 24 and h 48） on the two groups of the patients were compared,and the difference was not statistically significant（ P〉0. 05）. The difference of the sensory block and the motor block of the tibial nerve at the three time points（ h 12,h 24 and h 48） on the two groups of the patients were also compared,and the difference was not statistically significant（ P〉0. 05）. The difference of the sensory block and the motor block of common peroneal nerve at h 48 hs was statistically significant,group A was higher than the group B（ P〈0. 05）. The difference of the patient satisfaction at the three time points（ h12,h 24 and h 48） on the two groups was not statistically significant（ P〉0. 05）. Conclusion： The use of 0. 2% ropivacaine with the background volume of 3. 2 mL / h in continuous tibial nerve block can provide good analgesia and reduce the incidence of the sensory block and motor block of the common peroneal nerve.

关 键 词：跟骨 胫神经 神经传导阻滞 镇痛 罗哌卡因 

分 类 号：R329.28[医药卫生—人体解剖和组织胚胎学]