超声引导外周神经阻滞在老年患者大隐静脉手术中的应用  

作　　者：朱曼华 漆勇[1] 何慧娟 蔡畅[1] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院,315040

出　　处：《浙江临床医学》2020年第2期219-221,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2020359348)。

摘　　要：目的 观察超声引导下股神经、坐骨神经联合生殖股神经股支阻滞用于老年患者大隐静脉曲张手术的麻醉效果.方法 选择择期行单侧大隐静脉高位结扎加剥脱术的老年患者60例,年龄64~86岁,随机分为两组(n=30):椎管内麻醉组(S组),采用L3-4间隙行蛛网膜下腔阻滞;超声引导外周神经阻滞组(N组),采用股神经、坐骨神经联合生殖股神经股支阻滞麻醉.记录两组患者麻醉前(T0)、麻醉后10min(T1)、麻醉后30min(T2)及手术结束时(T3)的平均动脉压(MAP)、心率(HR),术中麻黄碱的使用情况及总输液量;记录两组麻醉操作时间、感觉阻滞起效时间、麻醉效果及患者麻醉满意度;记录术后24h的不良反应:包括恶心呕吐、头痛、尿潴留、穿刺部位疼痛、神经损伤、局部麻醉药中毒及穿刺部位血肿.结果 与T0时比较,S组T1时的MAP明显降低(P=0.006),T1时S组的MAP明显低于N组(P=0.030),S组术中输液量显著高于N组(P=0.000)及S组麻黄碱的使用率亦高于N组(P=0.004),N组患者的麻醉操作时间长于S组,S组患者的感觉阻滞起效时间短于N组,N组患者的术后的麻醉满意度评分高于S组(P=0.040),两组患者的麻醉效果比较差异无统计学意义;S组患者术后头痛、尿潴留及穿刺部位疼痛的发生率明显高于N组(P<0.05).结论 超声引导下股神经、坐骨神经联合生殖股神经股支阻滞用于老年患者大隐静脉曲张手术,麻醉效果确切,术中对血流动力学影响小,术后并发症少,患者满意度高.Objective To investigate the clinical efficacy of ultrasound-guided combined femoral-sciatic-femoral branch of genitofemoral nerve block in elderly patients undergoing saphenous varicose vein surgery.Methods Sixty elderly patients,aged 64—86 years,scheduled for unilateral long saphenous vein high ligation and stripping surgery were randomly divided into two groups(n=30 each):spinal anesthesia group(groupS):using spinal anesthesia in the L3~4 interspace,and ultrasound—guided peripheral nerve block(group N):using combined femoral—sciatic—femoral branch of genitofemoral nerve block.The MAP,HR were recorded before anesthesia(TO),10(Tl),3Omin(T2)and at the end of the surgery(T3).The use of ephedrine and total fluid volume during the surgery,the onset time of sensory block,anesthesia efficacy,patients’satisfaction degree of anesthesia,and the postoperative adverse reaction in the last 24 hours,including nausea and vomiting,headache,urinary retention,puncture site pain,nerve injury,local anesthetic intoxication and puncture site hematoma were also recorded.Results Compared with TO,the MAP was significantly decreased at Tl in group S(P=0.006).Compared with group N,the MAP was significantly lower at Tl in group S(P=0.030).The total fluid volume during the surgery were higher in group S than group N(P=0.000),and the use of ephedrine was also higher in group S than group N(P=0.004).The onset time of sensory block was shortened in group S,patients’satisfaction degree of anesthesia was higher in group N than in group S(P=0.040).There was no significant difference in the anesthesia efficacy between the two groups.The incidence of postoperative headache,urinary retention and puncture site pain was significantly higher in group A(P<0.05).Conclusion Ultrasound—guided combined femoral—sciatic—femoral branch of genitofemoral nerve block has an exact anesthetic effect,little effect on hemodynamics,fewer side effects and higher satisfaction degree in elderly patients undergoing saphenous varicose vein surgery.

关 键 词：超声引导 神经阻滞 椎管内麻醉 老年患者 

分 类 号：R61[医药卫生—外科学]