腹股沟韧带上髂筋膜阻滞对大隐静脉剥脱术患者术后镇痛效果的影响  

Effect of suprainguinal ligament iliac fascia block on postoperative analgesia in patients with great saphenous vein stripping

作　　者：刘琳 王辉 王铁全 刘禹含 Liu Lin;Wang Hui;Wang Tiequan;Liu Yuhan(Department of Anesthesiology,Daxing Hospital,to Capital Medical University,Beijing 102600,China;Department of Thoracic and Vascular Surgery,Daxing Hospital,Capital Medical University,Beijing 102600,China)

机构地区：[1]首都医科大学大兴教学医院麻醉科,北京102600 [2]首都医科大学大兴教学医院胸外血管外科,北京102600

出　　处：《血管与腔内血管外科杂志》2022年第2期215-219,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨腹肌沟韧带上髂筋膜阻滞对大隐静脉剥脱术患者术后镇痛效果的影响。方法 收集2019年3月至2021年3月于首都医科大学大兴教学医院接受大隐静脉高位结扎加剥脱术治疗的98例患者的临床资料。根据麻醉方式的不同将患者分为两组,全身麻醉组患者在全身麻醉下进行手术治疗,筋膜组患者在腹股沟韧带上髂筋膜阻滞麻醉下进行手术治疗,每组49例。比较两组患者术前(入室时)、术中(切皮时、切皮后30 min、术毕即刻)血流动力学指标,包括收缩压(SBP)、舒张压(DBP)、心率(HR)的变化情况;术后恢复指标,包括主动活动时间、卧床时间、住院时间。分别于术后1、8、24、48 h观察两组患者术后疼痛程度[视觉模拟评分量表(VAS)评分]。比较两组患者术后48 h内累计有效自控静脉镇痛(PCIA)泵按压次数、舒芬太尼累计用量,以及出院前麻醉不良反应的发生情况。结果 术中切皮时、切皮后30 min、术毕即刻,两组患者的SBP、DBP、HR均低于本组术前,且筋膜组患者的SBP均高于全身麻醉组患者;筋膜组患者切皮后30 min、术毕即刻的HR均高于全身麻醉组患者,术中切皮时、切皮后30 min的DBP均高于全身麻醉组患者(P<0.01)。筋膜组患者主动活动时间、卧床时间、住院时间均短于全身麻醉组患者(P<0.05);术后8、24、48 h筋膜组患者VAS评分均低于全身麻醉组患者,术后48h累计有效PCIA泵按压次数、舒芬太尼累计用量均少于全身麻醉组患者(P<0.05);筋膜组术后麻醉不良反应发生率低于全身麻醉组患者(P<0.05)。结论 腹股沟韧带上髂筋膜阻滞可减轻大隐静脉剥脱术患者血流动力学波动幅度,提高术后镇痛效果,减少术后镇痛阿片类药物用量,降低麻醉不良反应发生风险。Objective To investigate the effect of suprainguinal ligament fascia iliaca block on postoperative analgesia in patients with great saphenous vein stripping. Method Clinical data of 98 patients who underwent high ligation and stripping of great saphenous vein in Daxing Hospital, Capital Medical University from March 2019 to March 2021 were collected. According to different anesthesia methods, the patients were divided into two groups. The patients in the general anesthesia group were operated under general anesthesia, and the patients in the fascia group were operated under anesthesia of suprainguinal ligament fascia iliaca block, 49 cases in each group. The hemodynamic indexes, including systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR), were compared between the two groups before operation(entering the room) and during operation(skin cutting, 30 min after skin cutting and immediately after operation). Postoperative recovery indexes, including active activity time, bed time and hospital stay. The degree of postoperative pain was observed at 1, 8, 24 and 48 h after operation [visual analogue scale(VAS) score]. The cumulative effective compression times of patient controlled intravenous analgesia(PCIA) pump,the cumulative dosage of Sufentanil and the incidence of adverse anesthetic reactions before discharge were compared between the two groups within 48 hours after operation. Result The SBP, DBP and HR of the two groups were lower than those before operation at the time of intraoperative skin cutting, 30 minutes after skin cutting and immediately after operation, and the SBP of the fascia group was higher than that of the general anesthesia group(P<0.01). The HR of fascia group was higher than that of general anesthesia group at 30 minutes after skin cutting and immediately after operation, and the DBP of skin cutting during operation and 30 minutes after skin cutting was higher than that of general anesthesia group(P<0.05). The active activity time, bed time and hospital stay in the

关 键 词：大隐静脉曲张 高位结扎加剥脱术 髂筋膜阻滞 术后镇痛 

分 类 号：R543[医药卫生—心血管疾病]