超声引导下肢神经阻滞麻醉在膝关节以下改良穿支皮瓣V-Y治疗术中的应用  

Application of ultrasound-guided lower limb nerve block anesthesia in modified perforator flap V-Y treatment below knee joint

作　　者：蔡焕友 王传光[2] 蔡晓斌[3] 沈上荣 吴振华[2] 吴凌锋 吴铖炜 CAI Huanyou;WANG Chuanguang;CAI Xiaobin;SHEN Shangrong;WU Zhenhua;WU Lingfeng;Wu Chengwei(Department of Anesthesiology,Qingyuan People's Hospital in Zhejiang Province,Qingyuan 323300,China;Department of Anesthesiology,Lishui Central Hospital in Zhejiang Province,Lishui 323000,China;Department of Repair and Reconstruction of Hand Surgery,Lishui Center Hospital in Zhejiang Province,Lishui 323000,China)

机构地区：[1]浙江省庆元县人民医院麻醉科,浙江庆元323300 [2]浙江省丽水市中心医院麻醉科,浙江丽水323000 [3]浙江省丽水市中心医院修复重建手外科,浙江丽水323000

出　　处：《中国现代医生》2018年第16期119-123,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2015KYA243)

摘　　要：目的探讨超声引导下前路坐骨神经+股神经联合阻滞用于膝关节以下改良穿支皮瓣V-Y术患者的麻醉效果。方法选择2015年10月~2017年10月在庆元县人民医院和丽水市中心医院择期实施改良穿支皮瓣V-Y术的患者74例,随机分为前路超声引导下前路坐骨神经+股神经阻滞组(观察组)与单纯硬膜外阻滞组(对照组),每组37例。监测记录两组患者感觉神经阻滞起效时间、持续时间及操作时间;并用视觉模拟评分(VAS)法记录患者术后1 h、4 h、12 h、24 h的静息时疼痛强度及麻醉操作摆放时疼痛评分,监测两组患者麻醉前和麻醉后10、30 min及术毕、术后12 h的收缩压、舒张压、心率变化;术后首次进食时间,术后24 h内并发症、患者总体满意度等。结果麻醉后对照组患者SBP、DBP、HR显著低于麻醉前,与观察组比较,差异有统计学意义(P<0.05)。观察组操作时体位变动疼痛评分显著降低,术后镇痛维持时间较长,患者总体满意度高,与对照组比较,差异有统计学意义(P<0.05)。观察组术后并发症发生率也显著低于对照组,差异有统计学意义(P<0.05),但在术中止血带的耐受情况上观察组比对照组耐受性差,差异有统计学意义(P<0.05)。结论采用超声引导下坐骨神经+股神经联合阻滞用于膝关节以下改良穿支皮瓣V-Y术患者,操作方便,并发症少,麻醉效果好。Objective To investigate the anesthetic effect of ultrasound-guided anterior sciatic nerve combined with femoral nerve block in patients with modified perforator flap V-Y below knee joint.Methods 74 patients undergoing elective percutaneous perforator V-Y surgery from October 2015 to October 2017 in Qingyuan People's Hospital and Lishui Center Hospital were selected.They were randomly divided into anterior ultrasound-guided anterior sciatic nerve combined with femoral nerve block group(observation group)and epidural block group(control group),with 37 cases in each group.The onset time,duration time and operation time of sensory nerve block of the two groups were recorded.The visual analog scale(VAS)method was used to record the pain intensity at rest at 1 h,4 h,12 h,and 24 h after operation and the pain score during anesthesia operation position.The systolic blood pressure,diastolic blood pressure,and heart rate changes before anesthesia and at 10 and 30 minutes after anesthesia,after operation and at 12 hours after operation,time of first eating time,complications within 24 hours after surgery,overall patient satisfaction,etc.in two groups of patients were monitored.Results The SBP,DBP,and HR in the control group after anesthesia was significantly lower than that before anesthesia,and the difference was statistically significant between the control group and the observation group(P<0.05).In the observation group,the positional change pain score during operation significantly reduced and the duration of postoperative analgesia was longer,and the overall patient satisfaction was higher,and the difference was statistically significant between two groups(P<0.05).The incidence of postoperative complications was also significantly lower in the observation group than that in the control group,with statistically significant difference(P<0.05).However,the tolerability of the tourniquet in the observation group was poorer than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Ul

关 键 词：超声引导 神经阻滞 坐骨神经 股神经 穿支皮瓣 

分 类 号：R614[医药卫生—麻醉学]