超声引导联合神经刺激仪定位改良侧入法坐骨神经阻滞对老年T2DM下肢骨折患者术后的镇痛效果  

Effect of positioning modified lateral approach to sciatic nerve block by ultrasound combined nerve stimulator on postoperative analgesia and stress factors in elderly patients with T2DM complicated with lower extremity fracture

作　　者：陈爱鸾 陈健 吴勇 李成洁 张植兰 CHEN Ailuan;CHEN Jian;WU Yong;LI Chengjie;ZHANG Zhilan(Department oF Anesthesia,Hainan West Central Hospital,Danzhou 571700,Hainan,China;Department of Ultrasound,Haikou People's Hospital,Haikou 570100,Hainan,China)

机构地区：[1]海南西部中心医院麻醉科,海南儋州571700 [2]海口人民医院超声科,海南海口570100

出　　处：《贵州医科大学学报》2022年第10期1183-1188,共6页Journal of Guizhou Medical University

基　　金：海南省自然科学基金面上项目(819MS140)。

摘　　要：目的 探讨超声引导联合神经刺激仪定位改良侧入法坐骨神经阻滞对老年2型糖尿病(T2DM)下肢骨折患者术后镇痛效果及应激因子的影响。方法 94例老年T2DM下肢骨折患者均分为对照组和观察组,对照组给予神经刺激仪定位改良侧入法坐骨神经阻滞,观察组给予超声引导联合神经刺激仪定位改良侧入法坐骨神经阻滞;比较2组患者神经阻滞前(T0)及神经阻滞后10 min(T1)、30 min(T2)、60 min(T3)时点的心率(HR)、舒张压(DBP)、血氧饱和度(SaO_(2))及阻滞起效时间、阻滞完成时间、维持镇痛作用时间,检测2组患者术前及术后第1、3、7天时的血清肾上腺素(E)、血糖(GLU)、血管紧张素Ⅱ(AngⅡ),术后第1、3、7天时的疼痛程度(VAS)评分,比较2组患者治疗7 d时的不良反应发生情况。结果 观察组患者T1、T2、T3时点的DBP、HR低于对照组患者,阻滞起效及完成时间均短于对照组患者,维持镇痛时间长于对照组患者,差异有统计学意义(P <0.05);观察组患者术后第1、3及7天时的血清E、GLU、AngⅡ水平及VAS评分低于对照组,差异有统计学意义(P <0.05);观察组患者治疗期间的不良反应总发生率(4.26%)低于对照组(17.02%),差异有统计学意义(P <0.05)。结论 超声引导联合神经刺激仪定位改良侧入法坐骨神经阻滞对老年T2DM下肢骨折患者术后镇痛效果优于神经刺激仪定位改良侧入法坐骨神经阻滞,其机制可能与降低患者应激因子水平有关。Objective To investigate the effect of positioning modified lateral approach to sciatic nerve block by ultrasound combined nerve stimulator on postoperative analgesia and stress factors in elderly patients with type 2 diabetes mellitus(T2DM)complicated with lower extremity fracture.Methods Ninety-four elderly T2DM patients with lower extremity fractures were randomly divided into control group(n=47)and observation group(n=47).To position modified lateral approach to sciatic nerve block,control group was given a neurostimulator,while observation group was treated with an ultrasound-guided neurostimulator.Heart rate(HR),diastolic blood pressure(DBP),blood oxygen saturation(SaO_(2)),onset time of block,the time needed to complete block,the time needed to maintain analgesic effect were compared before nerve block(T0)and at 10 min(T1),30 min(T2),and 60 min(T3)after nerve block between two groups.Serum adrenaline(E),blood glucose(GLU),and angiotensin II(AngⅡ)were detected before surgery,on 1^(st),3^(rd),and 7^(th) days after surgery.Visual Analogue Scale(VAS)was used to assess pain intensity on 1^(st),3^(rd),and 7^(th) days after surgery.Adverse reactions were compared on 7th day after treatment between two groups.Results DBP and HR of patients in observation group at time points T1,T2,and T3 were lower than those in control group.The onset time of block and the time needed to complete block were shorter in observation than those in control group,but the time to maintain analgesia was longer than that in control group(P<0.05).The levels of serum E,GLU,AngⅡ,and VAS scores in observation group on 1^(st),3^(rd),and 7^(th) days after surgery were lower than those in control group(P<0.05).The total incidence of adverse reactions was statistically significantly lower(4.26%vs.17.02%)in observation group versus control group(P<0.05).Conclusion Ultrasound combined with nerve stimulator in analgesic effect is superior to nerve stimulator in positioning modified lateral approach to sciatic nerve block in elderly T2DM patients

关 键 词：2型糖尿病 下肢骨折 超声引导 神经刺激仪 坐骨神经阻滞 应激因子 

分 类 号：R614[医药卫生—麻醉学]