超声引导下经皮腔内血管成形术麻醉方式的探讨  

Comparison of Different Anesthesia Methods in Ultrasound-Guided Percutaneous Transluminal Angiography Therapy

作　　者：余杨 刘蔚[2] 邓又斌[2] 叶蕾[1] YU Yang;LIU Wei;DENG Youbin;YE Lei(Department of Ultrasound,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,Hubei,China;Department of Nephrology,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院超声科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院肾内科,湖北武汉430030

出　　处：《江汉大学学报（自然科学版）》2021年第3期79-83,共5页Journal of Jianghan University：Natural Science Edition

摘　　要：目的探讨超声引导下透析用动静脉内瘘经皮腔内血管成形术中采用不同的麻醉方式的镇痛效果。方法纳入2017年10月至2019年7月行超声引导下经皮腔内血管成形术共93例患者进行研究,患者采用随机分组的方式分为4组,其中无麻醉组20例,采用表面麻醉组27例,采用局部浸润麻醉组22例,采用高选择性局部神经阻滞麻醉组24例,观察其麻醉效果、实施麻醉的操作时间及术后并发症。结果无麻醉组和表面麻醉组疼痛评分显著高于局部浸润麻醉组和神经阻滞组。无麻醉组疼痛评分最高,显著高于其他麻醉组;表面麻醉组疼痛评分居中,显著高于高选择性局部神经阻滞麻醉组和局部浸润麻醉组。高选择性局部神经阻滞麻醉组和局部浸润麻醉组疼痛评分差异无统计学意义。在实施麻醉的操作时间上,高选择性局部神经阻滞麻醉组操作时间最长,显著延长了手术时间。在术后并发症的观察中,表面麻醉组出现了1例局部红斑,局部浸润麻醉组出现了2例血管损伤,高选择性局部神经阻滞麻醉组出现了1例肌间血肿。结论局部浸润麻醉和高选择性局部神经阻滞麻醉对于患者的手术疼痛耐受度较好,但是需要避免并发症的发生。高选择性局部神经阻滞麻醉和局部浸润麻醉的镇痛效果最好,但是高选择性局部神经阻滞麻醉显著延长了手术时间。表面麻醉有一定的镇痛效果,可以适用于疼痛不敏感的患者。3种麻醉方式都无严重并发症的发生。Objective To compare the analgesic effect of different anesthetic methods in ultrasound-guided percutaneous transluminal angiography(PTA)therapy for dialysis arteriovenous fistula(AVF)stenosis.Methods Ultrasound-guided PTA was performed on 93 hemodialysis patients with AVF stenosis from October 2017 to July 2019.Patients were randomized into four groups:no anesthesia group(n=20),surface anesthesia group(n=27),local infiltration anesthesia(n=22),high selective local nerve block anesthesia group(n=24),to observe the anesthesia effect,the operating time(including onset and duration)and the postoperative complications.Results The pain score of the no anesthesia group and surface anesthesia group were significantly higher than the other two groups.The pain score of the no anesthesia group was the highest,which was significantly higher than that of the other anesthesia groups.The pain score of the surface anesthesia group was in the middle,which was significantly higher than that of the highly selective local nerve block group and the local infiltration anesthesia group.There was no significant difference in pain score between the highly selective local nerve block group and the local infiltration anesthesia group.In terms of anesthesia time,the highly selective local nerve block group had the longest operation time,which significantly prolonged the operation time.During the observations of postoperative complications,one case of local erythema occurred in the surface anesthesia group,two cases of blood vessel injuries occurred in the local infiltration anesthesia,and one case of intramuscular hematoma occurred in the highly selective local nerve block group.Conclusion Local infiltration anesthesia and high selective local nerve block anesthesia are well tolerated for patients’surgical pain,but should be noted to avoid complications.Although the two groups have obviously better analgesic effects,in the highly selective local nerve block group,the operation time has markedly prolonged.Surface anesthesia has limited an

关 键 词：超声引导下经皮腔内血管成形术 表面麻醉 局部浸润麻醉 高选择性局部神经阻滞 

分 类 号：R445.1[医药卫生—影像医学与核医学] R614[医药卫生—诊断学]