神经阻滞与全身麻醉在糖尿病足行胫骨横向骨搬移术患者中的应用效果对比  

Comparative analysis of nerve block and general anesthesia in diabetic foot patients undergoing transverse tibial bone transport

作　　者：杨艳艳 冯丝丝 林成新[1] Yang Yanyan;Feng Sisi;Lin Chengxin(Department of Anesthesiology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院麻醉科

出　　处：《广西医科大学学报》2019年第9期1410-1414,共5页Journal of Guangxi Medical University

基　　金：广西自然科学基金资助项目(2016GXNSFAA380299)

摘　　要：目的:比较分析神经阻滞与全身麻醉对糖尿病足行胫骨横向骨搬移术患者术中血流动力学、住院时间及术后并发症的影响。方法:回顾性分析96例行糖尿病足胫骨横向骨搬移术患者的临床资料,其中全身麻醉组为G组,神经阻滞组为N组,为有效降低混杂因素影响,采用倾向性评分匹配(PSM),均衡两组间混杂因素的差异,提高统计效能。比较两组麻醉开始前(T0)及手术开始后10min(T1)、20min(T2)、30min(T3)、40min(T4)、50min(T5)、60min(T6)的收缩压(SBP)、舒张压(DBP)和心率(HR),观察术中血流动力学变化、住院时间和术后并发症。结果:PSM成功匹配25对(G组25例,N组25例)。匹配后N组T1时点HR及T2~T6时点SBP、DBP、HR较G组更稳定(P<0.05)。N组术中输液量、麻黄素使用例数、低血压发生率、总住院时间均明显低于G组(均P<0.05)。两组术中出血量、乌拉地尔使用率、高血压发生率、术后并发症、术后住院时间比较,差异均无统计学意义(均P>0.05)。结论:糖尿病足患者行胫骨横向骨搬移术,与全身麻醉相比,神经阻滞术中血流动力学稳定,值得临床推广应用。Objective:To compare and analyze the effects between peripheral nerve block and general anesthesia on hemodynamics,length of stay in hospital and post-operative complications in diabetic foot patients undergoing transverse tibial bone transport.Methods:A total of 96 consecutive diabetic foot patients who underwent transverse tibial bone transport were retrospectively reviewed.Patients received general anesthesia(group G,n=31)or peripheral nerve block(group N,n=65).The propensity score matching method was adopted and finally 25 pairs were successfully matched.Systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were recorded before induction(T0),and at 10 minutes(T1),20 minutes(T2),30 minutes(T3),40 minutes(T4),50 minutes(T5),60 minutes(T6)after the surgery begen.The hemodynamics,length of stay in hospital and post-operative complications were assessed.Results:HR at T1,SBP,DBP and HR at T2-T6 in group N were more stable than those in group G(P<0.05).The intra-operative infusion volume,use cases of ephedrine,the incidence of hypotension and the hospitalization days in group G were higher than those in group N(P<0.05).There were no significant difference between the two groups in the amount of Intra-operative blood loss,use cases of urapidil,the incidence of hypertension,post-operative complications and post-operative hospitalization days(P>0.05).In group G,there were 1 case of septic shock,1 case of acute heart failure,while no post-operative complications were observed in group N.Conclusion:Nerve block for the surgery of transverse tibial bone transport in diabetic foot patients has the advantages of stable hemodynamics,without post-operative complications,it also requires less hospitalization days when compared with general anesthesia,which worths the clinical application.

关 键 词：神经阻滞 糖尿病足 血流动力学 术后并发症 胫骨横向骨搬移术 

分 类 号：R614[医药卫生—麻醉学]