神经阻滞与全身麻醉在跟骨骨折内固定术后疼痛控制中的价值  

Values of Nerve Block and General Anesthesia in Pain Control after Internal Fixation of Calcaneal Fracture

作　　者：张海华[1] 熊华平 李巧云[1] 胡吉[1] 刘金花 ZHANG Hai-hua;XIONG Hua-ping;LI Qiao-yun;HU Ji;LIU Jin-hua(Department of Anesthesiology,the 910th Hospital of the Chinese People's Liberation Army Joint Service,Quanzhou,Fujian,362000,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院麻醉科,福建泉州362000

出　　处：《现代生物医学进展》2021年第1期104-107,共4页Progress in Modern Biomedicine

基　　金：福建省自然科学基金项目(2015J01597);泉州市科技计划项目(2018Z151)。

摘　　要：目的:探讨神经阻滞与全身麻醉在跟骨骨折内固定术后疼痛控制中的价值。方法:2019年1月到2019年10月选择在本院诊治的开放性跟骨骨折患者480例,按照入院顺序,根据随机数字表法分为研究组与对照组,各240例。所有患者都给予跟骨骨折内固定治疗与全身麻醉,观察组术后给予连续坐骨神经自控镇痛,对照组术后给予静脉自控镇痛,记录疼痛控制效果。结果:两组的手术时间、引流时间、引流量等对比差异无统计学意义(P>0.05),研究组的切口干燥时间与切口愈合时间显著短于对照组(P<0.05)。观察组术后4 h、24 h与48 h的疼痛视觉模拟评分法(Visual analog scales,VAS)评分显著低于对照组(P<0.05)。两组术后48 h的感觉阻滞情况0级、1级、2级对比差异无统计学意义(x2=0.00、0.083、0.083,P=1.0、0.773、0.773),组间对比均无统计学意义(P>0.05)。研究组术后1个月的切口裂开、感染、皮下血肿与皮缘坏死等并发症发生率为4.2%,显著低于对照组的15.8%(x2=18.148,P=0.000),两组对比有显著的统计学意义(P<0.001)。结论:神经阻滞与全身麻醉在跟骨骨折内固定术后的应用具有更好的镇痛效果,且不影响阻滞效果,能促进患者康复,减少术后并发症的发生。Objective: To explore the values of nerve block and general anesthesia in pain control after internal fixation of calcaneal fractures. Methods: From January 2019 to October 2019, 480 cases of patients with open calcaneal fractures were selected for diagnosis and treatment in our hospital and were divided into study group and control group of 240 patients in each groups accorded to the order of admission and the random number table method. All patients were treated with calcaneal fractures internal fixation and general anesthesia. The observation group were given continuous self-controlled analgesia of the sciatic nerve after operation, and the control group were given intravenous self-controlled analgesia. Results: There were no statistically significant difference in surgical time,drainage time, and drainage volume compared between the two groups(P>0.05). The incision drying time and incision healing time in the study group were significantly shorter than those in the control group(P<0.05). The pain VAS scores of the observation group at 4 h,24 h and 48 h after operation were significantly lower than those of the control group(P<0.05). There was no statistically significant difference in the level of sensory block between the two groups at 0, 1, and 2(x2 = 0.00, 0.083, 0.083, P=1.0, 0.773, 0.773). There was no statistical comparison between the two groups(P>0.05). The incidence of complications such as incision dehiscence, infection,subcutaneous hematoma, and marginal necrosis was 4.2 % in the study group at 1 month after operation, which was significantly lower than 15.8 % in the control group(x2=18.148, P=0.000). There was statistical significance(P<0.001). Conclusion: The application of nerve block and general anesthesia after internal fixation of calcaneal fractures has better analgesic effect, it does not affect the block effect, can promote patient recovery, and reduce the incidence of postoperative complications.

关 键 词：神经阻滞 全身麻醉 跟骨骨折 内固定 并发症 

分 类 号：R683.42[医药卫生—骨科学] R274.1[医药卫生—外科学]