改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的应用  

Application of modified fascia iliaca compartment block combined with popliteal fossa sciatic nerve block in patients undergoing unilateral great saphenous varicose veins surgery

作　　者：章敏[1] 谢言虎[1] 音樱[1] 周玲[1] 柴小青[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2016年第5期430-433,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察改良髂筋膜间隙联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的麻醉效果。方法选择择期行单侧大隐静脉高位结扎加抽剥术患者60例,男32例,女28例,年龄42~76岁,ASAⅠ或Ⅱ级,采用随机数字表法将其分为改良髂筋膜间隙联合腘窝坐骨神经阻滞组（N组）和硬膜外阻滞组（E组）,每组30例。N组先行腘窝坐骨神经阻滞,再在超声图像上确认髂筋膜和股神经位置,先行股神经阻滞,再在同一穿刺点从缝匠肌内侧缘开始,由外向内沿髂筋膜下给1%利多卡因10ml和0.5%罗哌卡因10ml,同时超声探头在腹股沟韧带水平向内移动,内侧达股动脉上方;E组采用L2~3间隙行硬膜外阻滞。记录两组阻滞前（T0）、阻滞后10min（T1）、30min（T2）、60min（T3）的SBP、DBP及HR;记录两组阻滞完成时间、感觉阻滞起效时间、术中麻黄碱使用情况、麻醉效果及术后48h恶心呕吐、头痛及尿潴留发生情况。结果与T0时比较,T2时E组的SBP和DBP明显降低（P〈0.05）,T2时N组SBP和DBP明显高于E组（P〈0.05）;N组感觉阻滞起效时间明显短于E组、术中麻黄碱使用率明显低于E组（P〈0.05）;E组整体麻醉效果优于N组（P〈0.05）,但两组麻醉效果优良率差异无统计学意义;术后48hN组尿潴留发生率明显低于E组（P〈0.05）。结论改良髂筋膜间隙联合腘窝坐骨神经阻滞用于单侧大隐静脉高位结扎加抽剥术中,麻醉效果良好,较硬膜外阻滞具有血流动力学影响小、术后并发症少及适应证更广等优点。Objective To investigate the clinical efficacy of ultrasound-guided and nerve stimulator-guided modified fascia iliaca compartment block combined with popliteal fossa sciatic nerve block in patients undergoing unilateral great saphenous varicose veins surgery.Methods Sixty patients,male 32 and female 28,aged 42-76 years,ASA ⅠorⅡ,scheduled for unilateral great saphenous varicose veins surgery were randomly divided into two groups（n=30each）：modified fascia iliaca compartment block with popliteal fossa sciatic nerve block group（group N）and epidural anesthesia（group E）.Firstly,popliteal fossa sciatic nerve block was performed in group N.Then confirmed iliac fascia and femoral nerve position on the ultrasonic image and the femoral nerve was blocked.The 1%lidocaine 10 milliliters and 0.5% ropivacaine 10 milliliters were injected in the fascia iliaca compartment block from medial border of sartorius to upward site of femoral artery.Meanwhile,the ultrasonic probe was moving inside in the level of inguinal ligament.The SBP,DBP and HR were recorded before block（T0）,10（T1）,30（T2）and 60minutes（T3）after block.The block working time and onset time of sensory block,use of ephedrine after anesthesia,anesthesia efficacy and the postoperative adverse reactions in the last 48 hours,including nausea,vomiting,headache and urinary retention,were also recorded.Results Compared with T0,the SBP and DBP was significantly decreased at T2 in group E（P〈0.05）.Compared with group E at the same time,the SBP and DBP was significantly higher at T2 in group N（P〈0.05）.The onset time of sensory block was significantly shortened and the use of ephedrine after anesthesia was also less in group N（P〈0.05）.Group E was better than group N in the whole anesthesia efficacy（P〈0.05）,but there was no significant difference in the excellent rate of anesthesia efficacy between the two groups.The incidence of postoperative urinary retention was significantly decreased in group N（P〈0.05）and there was

关 键 词：坐骨神经阻滞 髂筋膜间隙阻滞 硬膜外阻滞 

分 类 号：R614[医药卫生—麻醉学]