神经阻滞麻醉对大隐静脉曲张患者大隐静脉高位结扎剥脱术相关临床指标的影响  

Influence of nerve block anesthesia on clinical indicators related to high ligation and stripping of great saphenous vein in patients with varicose great saphenous vein

作　　者：夏良勇[1] 董春山[1] 李蕾[1] 程思[1] 马祥[1] 吴忠寅[2] Xia Liangyong;Dong Chunshan;Li Lei;Cheng Si;Ma Xiang;Wu Zhongyin(Department of Anesthesiology,Hefei First People's Hospital,Hefei 230061,Anhui,China;Department of Vascular Surgery,Hefei First People's Hospital,Hefei 230061,Anhui,China)

机构地区：[1]合肥市第一人民医院麻醉科,安徽合肥230061 [2]合肥市第一人民医院血管外科,安徽合肥230061

出　　处：《血管与腔内血管外科杂志》2022年第4期473-478,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨神经阻滞麻醉对行大隐静脉高位结扎剥脱术的大隐静脉曲张患者术中血流动力学与术后应激反应的影响。方法收集2019年1月至2021年12月于合肥市第一人民医院接受大隐静脉高位结扎剥脱术治疗的82例大隐静脉曲张患者的临床资料,并根据麻醉方式的不同将患者分为全身麻醉组(采用喉罩全身麻醉)和阻滞组(采用超声引导下隐神经阻滞麻醉联合喉罩全身麻醉),每组41例。比较两组患者术前、术中血流动力学指标,包括心率(HR)、平均动脉压(MAP)。比较两组患者术后1、8、24、48 h的疼痛程度;术前及术后24 h血清炎性反应指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、氧化应激反应指标[超氧化物歧化酶(SOD)、活性氧(ROS)、谷胱甘肽过氧化物酶(GSH-Px)、皮质醇(Cor)]、凝血功能指标[凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)、D-二聚体(D-D)]。比较两组患者术中麻醉效果不佳与术后麻醉不良反应的发生情况。结果术中,阻滞组患者的MAP、HR均高于全身麻醉组患者,差异均有统计学意义(P<0.05)。术后8、24 h,阻滞组患者的VAS评分均低全身麻醉组患者,术后48 h内舒芬太尼用量均低于全身麻醉组患者,差异均有统计学意义(P<0.05)。术后24 h,阻滞组患者的血清CRP、IL-6、TNF-α、Cor水平及ROS均低于全身麻醉组患者,SOD、GSH-Px均高于全身麻醉组患者,差异均有统计学意义(P<0.05)。术后24 h,阻滞组患者的APTT、PT、TT均长于全身麻醉组患者,Fib、D-D水平均低于全身麻醉组患者,差异均有统计学意义(P<0.05)。结论神经阻滞麻醉能够更好地维持行大隐静脉高位结扎剥脱术的大隐静脉曲张患者术中血流动力学的稳定,减轻患者术后应激反应程度,麻醉安全性更高。Objective To investigate the effect of nerve block anesthesia on intraoperative hemodynamics and postoperative stress response in patients with high ligation and stripping of great saphenous vein in patients with varicose great saphenous vein.Method The clinical data of 82 patients with varicose great saphenous vein treated by high ligation and stripping of great saphenous vein in Hefei First People's Hospital from January 2019 to December 2021 were collected.According to different anesthesia methods,the patients were divided into general anesthesia group(laryngeal mask general anesthesia)and blocking group(ultrasound-guided saphenous nerve block anesthesia combined with laryngeal mask general anesthesia),with 41 cases in each group.The preoperative and intraoperative hemodynamic indexes,including heart rate(HR)and mean arterial pressure(MAP),were compared between the two groups.The degree of pain at 1,8,24 and 48 hours after operation was compared between the two groups;the serum inflammatory response indexes before and 24 hours after operations[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],indicators of oxidative stress response[superoxide dismutase(SOD),reactive oxygen species(ROS),glutathione peroxidase(GSH-Px),cortisol(Cor)],indicators of coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),thrombin time(TT),D-dimer(D-D)].The poor effect of intraoperative anesthesia and the incidence of postoperative adverse anesthetic reactions were compared between the two groups.Result During the operation,the map and HR of patients in blocking group were higher than those in general anesthesia group,and the difference was statistically significant(P<0.05).At 8 and 24 hours after operation,the VAS scores of patients in the blocking group were lower than those in the general anesthesia group,and the dosage of sufentanil within 48 hours after operation was lower than that in the general anesthesia group(P<0.05).At 24 hours after operation,the l

关 键 词：大隐静脉高位结扎剥脱术 血流动力学 神经阻滞麻醉 全身麻醉 炎性反应 氧化应激反应 凝血功能 

分 类 号：R543[医药卫生—心血管疾病]