椎管内麻醉联合超声引导腘窝坐骨神经鞘膜下阻滞在足踝手术中的应用效果  

Effect of intraspinal anesthesia combined with ultrasound-guided subcapsular block of popliteal sciatic nerve in foot and ankle surgery

作　　者：韦宁仙[1] 沈春敏 汤秀燕 刘香 邓泳 秦迎春[1] Wei Ningxian;Shen Chunmin;Tang Xiuyan;Liu Xiang;Deng Yong;Qin Yingchun(Department of anesthesiology,Danyang People’s Hospital,Danyang,212300,China)

机构地区：[1]丹阳市人民医院麻醉科,江苏丹阳212300

出　　处：《足踝外科电子杂志》2022年第1期64-68,共5页Electronic Journal of Foot and Ankle Surgery

基　　金：镇江市社会发展项目(SH2013045)。

摘　　要：目的探讨在足踝手术中采用椎管内麻醉联合超声引导腘窝坐骨神经鞘膜下阻滞的效果。方法选择丹阳市人民医院2018年1月至2021年10月收治的足踝手术患者60例,以随机数字表法分为两组,对照组(n=30)予蛛网膜下腔阻滞,观察组(n=30)予蛛网膜下腔阻滞联合超声引导腘窝坐骨神经鞘膜下阻滞,比较两组运动与感觉阻滞的起效、完善、维持时间;分析患者术中血流动力学指标的改变;检测术前、术后的皮质醇(cortisol,Cor)、儿茶酚胺(catecholamine,CA)水平,以评估机体应激反应;并统计两组的不良反应发生率,采用视觉模拟法评估患者的术后疼痛评分。结果观察组运动阻滞起效、完善时间分别为(15.22±1.74)min、(24.09±1.35)min,感觉阻滞起效、完善时间分别为(5.85±1.14)min、(20.34±3.10)min,均短于对照组,差异有统计学意义(t=3.169、5.566、4.963、4.326,P<0.05);运动与感觉阻滞维持时间分别为(245.51±26.87)min、(297.20±25.38)min,均长于对照组,差异有统计学意义(t=6.981、9.077,P<0.05)。观察组切皮时、缝皮时心率分别为(71.61±4.29)次/min、(70.95±4.62)次/min,平均动脉压水平分别为(79.36±6.54)mmHg、(78.96±5.86)mmHg,均高于对照组,差异有统计学意义(t=2.862、3.145、4.775、6.115,P<0.05)。观察组术后Cor、CA水平分别为(323.42±16.55)mmol/L、(356.02±30.49)ng/L,均低于对照组,差异有统计学意义(t=3.394、4.253,P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(2.33%vs 26.67%,x^(2)=4.706,P<0.05)。观察组术后6 h、12 h的疼痛评分分别为(1.50±0.40)分、(2.71±0.93)分,均低于对照组,差异有统计学意义(t=9.476、7.104,P<0.05)。结论在足踝手术中采用椎管内麻醉联合超声引导腘窝坐骨神经鞘膜下阻滞方案,麻醉起效快且持续时间长,可维持术中血流动力学指标稳定,能减轻患者的应激反应,不良反应风险更低,术后镇痛效果好,值得推广。Objective To investigate the effect of intraspinal anesthesia combined with ultrasound-guided subsheath block of popliteal sciatic nerve in foot and ankle surgery.Methods A total of 60 patients with foot and ankle surgery admitted from January 2018 to October 2021 were randomly divided into two groups,the control group(n=30)was subjected to subarachnoid block,and the observation group(n=30)was combined with ultrasound-guided subsheath block of popliteal sciatic nerve.The effect,improvement and maintenance time of motor and sensory block were compared between the two groups.The changes of intraoperative hemodynamic indexes,Cor and CA levels and adverse reactions(ADR)were analyzed.Visual simulation was used to evaluate postoperative pain scores.Results The onset time and improvement time of motor block in observation group were(15.22±1.74)min and(24.09±1.35)min respectively,and the onset time and improvement time of sensory block were(5.85±1.14)min and(20.34±3.10)min respectively,which were shorter than those in control group(t=3.169,5.566,4.963,4.326,P<0.05).The maintenance time of motor and sensory block(245.51±26.87)min and(297.20±25.38)min were higher than that of the control group(t=6.981,9.077,P<0.05).The heart rate of the observation group was(71.61±4.29)times/min and(70.95±4.62)times/min,and the average arterial pressure was(79.36±6.54)mmHg and(78.96±5.86)mmHg,respectively,higher than that of the control group(t=2.862,3.145,4.775,6.115,P<0.05).The levels of Cor and CA in the observation group were(323.42±16.55)mmol/L and(356.02±30.49)ng/L,respectively,lower than those in the control group(t=3.394,4.253,P<0.05).The incidence of ADR in the observation group was lower than that in the control group(2.33%vs 26.67%,x^(2)=4.706,P<0.05).The pain scores of the observation group were(1.50±0.40)points and(2.71±0.93)points at 6 h and 12 h after operation,which were lower than those of the control group.Conclusion In foot and ankle surgery,intraspinal anesthesia combined with ultrasound-guided subsheath a

关 键 词：椎管内麻醉 超声引导 腘窝坐骨神经 鞘膜下阻滞 血流动力学 

分 类 号：R683.42[医药卫生—骨科学]