不同入路坐骨神经阻滞对踝部骨折患者镇痛效果及应激的影响  

The effect of different approaches of sciatic nerve block on analgesia and stress in patients with ankle fracture

作　　者：张诚章[1] 李振威[1] 余建华[1] 彭德良[1] 廖荣宗[1] ZHANG Cheng-zhang;LI Zhen-wei;YU Jian-hua;PENG De-liang;LIAO Rong-zong(Department of Anesthesiology, Foshan Hospital of Traditional Chinese Medicine, Guangdong Province, Foshan 528000, China)

机构地区：[1]广东省佛山市中医院麻醉科,广东佛山528000

出　　处：《河北医科大学学报》2022年第4期466-469,475,共5页Journal of Hebei Medical University

基　　金：佛山市科技局自筹经费类科技计划项目(医学类科技攻关)(1920001000263)。

摘　　要：目的探究不同入路(经股骨大转子平面入路与经腘窝上入路)坐骨神经阻滞应用于踝部骨折患者手术过程的镇痛效果,以及对应激状态的影响。方法选踝部骨折患者78例,基于随机数字表法简单随机分为A组(经股骨大转子平面入路行坐骨神经麻醉阻滞)与B组(经腘窝上入路行坐骨神经麻醉阻滞),每组39例。比较2组神经阻滞相关指标、术后不同时间节点疼痛感受视觉模拟评分法(visual analogue scale,VAS)评分、以及术后8 h股后肌群肌力,并记录不良反应发生情况。结果B组感觉阻滞起效时间、神经阻滞操作时间、坐骨神经深度、术中芬太尼用量及术后8 hVAS评分均明显低于A组,差异有统计学意义(P<0.05)。麻醉后15 min、30 min,B组收缩压、舒张压及心率均明显低于A组,差异有统计学意义(P<0.05),2组在组间、时点间、组间·时点间交互作用方面差异有统计学意义(P<0.05)。B组术后8 h股后肌群肌力等级整体明显高于A组,差异有统计学意义(P<0.05)。2组均无不良反应情况发生。结论相较于股骨大转子入路,腘窝上入路行坐骨神经阻滞操作更简捷,镇痛效果更为显著,并且能够更好地保留股后肌群肌力。Objective To explore the analgesic effect of different approaches(transtrochanteric planar approach and transpopliteal approach)of sciatic nerve block applied to patients with ankle fracture during surgery,and their impact on stress state.Methods A total of 78 patients with ankle fractures were selected,and based on the random number table method,they were divided into group A(sciatic nerve anesthesia block via the greater trochanter plane approach)and group B(sciatic nerve anesthesia block via the upper popliteal approach),with 39 cases in each group.Nerve block-related indicators,visual analogue scale(VAS)scores for pain at different time points after surgery,and muscle strength of the posterior femoral muscles at 8 h after surgery were compared,and the occurrence of adverse reactions was recorded.Results Onset time of sensory block,operation time of nerve block,depth of sciatic nerve,the dosage of intraoperative fentanyl and the VAS score at 8 h after surgery were significantly lower in group B than in group A,and the difference was statistically significant(P<0.05).At 15 min and 30 min after anesthesia,the systolic blood pressure,diastolic blood pressure and heart rate of group B were significantly lower than those of group A,with significant difference(P<0.05).The differences of interaction between groups,time points and time points between groups were statistically significant(P<0.05).The overall muscle strength of the posterior femoral muscles of group B was significantly higher than that of group A at 8 h after surgery,and the difference was statistically significant(P<0.05).No adverse reactions occurred in the two groups.Conclusion Compared with the greater trochanter approach,the upper popliteal approach for sciatic nerve block is simpler and has a more significant analgesic effect,and it can better retain the muscle strength of the posterior femoral muscles.

关 键 词：踝骨折 坐骨神经 超声处理 

分 类 号：R683.425[医药卫生—骨科学]