腘窝坐骨神经阻滞与椎管内麻醉在足部手术中的应用效果研究  

Effect of Popliteal Sciatic Nerve Block and Intraspinal Anesthesia in Foot Surgery

作　　者：张志辉 马淑娟 柯建辉 谢亦栋 徐俊 Zhang Zhihui;Ma Shujuan;Ke Jianhui;Xie Yidong;Xu Jun(Anesthesiology Maternal and Child Health Hospital Department of Anesthesiology,Zhenjiang 212300,China)

机构地区：[1]江苏省丹阳市妇幼保健院麻醉科,江苏镇江212300

出　　处：《足踝外科电子杂志》2020年第4期14-17,共4页Electronic Journal of Foot and Ankle Surgery

基　　金：江苏省自然科学基金项目(BL20126052)。

摘　　要：目的探讨腘窝坐骨神经阻滞与椎管内麻醉在足部手术中的应用效果。方法选择江苏省丹阳市妇幼保健院2017年1月—2019年12月收治的行足部手术治疗的70例患者作为研究对象,按随机数字表法分为对照组与观察组,各35例。对照组行椎管内麻醉,观察组在神经刺激器定位下行腘窝坐骨神经阻滞,评价两组麻醉效果及不良反应发生率,记录感觉与运动阻滞起效及持续时间,测定术中不同时间点心率及动脉压变化。结果观察组麻醉优良率为97.14%,对照组麻醉优良率为94.29%,两组比较差异无统计学意义(P>0.05)。观察组低血压、心动过缓、恶心呕吐、穿刺不适、误伤血管发生率低于对照组,差异有统计学意义(P<0.05)。观察组运动神经及感觉神经的起效时间低于对照组,持续时间长于对照组,差异有统计学意义(P<0.05)。切皮时与缝皮时,观察组HR及MAP高于对照组,差异有统计学意义(P<0.05)。结论与椎管内麻醉相比,足部手术中采取腘窝坐骨神经阻滞可获得相近的麻醉效果,维持良好肌松,手术得以顺利展开,而且阻滞起效时间短、持续时间长、术中生命体征稳定、应激反应轻、不良反应少、安全性高,值得推广。Objective To investigate the effect of popliteal sciatic nerve block and intraspinal anesthesia in foot surgery.Methods 70 cases of patients who underwent foot surgery in Jiangsu Danyang Maternal and Child Health Care Hospital from January 2017 to December 2019 were selected as research object.They were randomly divided into two groups,with 35 cases in each group.The control group received intraspinal anesthesia,while the observation group received popliteal sciatic nerve block under the position of nerve stimulator.The anesthesia effect and adverse reaction rate of the two groups were evaluated.The onset and duration of sensory and motor block were recorded,and the changes of heart rate and arterial pressure at different time points during the operation were measured.Results The excellent and good rate of anesthesia in the observation group was 97.14%,while that in the control group was 94.29%.There was no significant difference between the two groups(P>0.05).The incidence of hypotension,bradycardia,nausea and vomiting,puncture discomfort and accidental vascular injury in the observation group was significantly lower than that in the control group(P<0.05).The onset time of motor nerve and sensory nerve in the observation group was significantly lower than that in the control group,and the duration was significantly longer than that in the control group(P<0.05).HR and MAP were maintained well in the observation group at the time of skin incision and skin suture,with statistically significant difference(P<0.05).Conclusion Compared with intraspinal anesthesia,popliteal sciatic nerve block in foot surgery can achieve similar anesthetic effect,maintain good muscle relaxation,and smooth operation.In addition,the onset of block is short and the duration is long.It maintains the stability of vital signs,with mild stress response,less adverse reactions,and high safety,which is worthy of promotion.

关 键 词：腘窝坐骨神经阻滞 椎管内麻醉 足部手术 不良反应 麻醉效果 

分 类 号：R64[医药卫生—外科学]