超声引导下腹股沟韧带上髂筋膜间隙阻滞联合外侧入路坐骨神经阻滞对下肢创伤术后加速康复的影响  

Effects of Ultrasound⁃Guided Supra⁃Inguinal Fascia Iliaca Block Combined with Lateral Approach to Sciatic Nerve Block on Postoperative Rehabilitation of Patients with Lower Limb Trauma

作　　者：赖艳芳 林晓婷 曹慧娟 刘珊珊 程森 LAI Yan-fang;LIN Xiao-ting;CAO Hui-juan;LIU Shan-shan;CHENG Sen(Department of Anesthesiology,Army Hospital of the 73rd Army Group,Xiamen 361001,China)

机构地区：[1]陆军第73集团军医院麻醉科,福建厦门361001

出　　处：《骨科》2023年第3期270-273,共4页ORTHOPAEDICS

基　　金：厦门市科技计划指导性项目(3502Z20214ZD1186)。

摘　　要：目的探讨超声引导下腹股沟韧带上髂筋膜间隙阻滞(supra⁃inguinal fascia iliaca compart⁃ment block,S⁃FICB)联合外侧入路坐骨神经阻滞对下肢创伤病人术后加速康复效果的影响。方法选择下肢创伤病人100例,采用随机数字法分组。观察组50例,采用超声引导下S⁃FICB联合外侧入路坐骨神经阻滞;对照组50例,采用L3/4硬膜外麻醉。记录两组麻醉前(T0)、麻醉后10 min(T1)、麻醉后30 min(T2)、60 min(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)及麻黄碱使用情况;记录两组麻醉效果、病人舒适满意度、术中恶心呕吐情况,以及术后48 h内恶心呕吐及尿潴留的发生情况。结果两组麻醉效果的差异无统计学意义(P>0.05);观察组病人的术前舒适满意度优于对照组,术中麻黄碱使用量低于对照组,术后48 h尿潴留、恶心呕吐发生率明显低于对照组,差异有统计学意义(P<0.05)。与T0时比较,对照组T1、T2时的SBP和DBP明显降低(P<0.05);对照组T1、T2时的SBP显著低于观察组,T2时的DBP显著低于观察组,组间比较,差异有统计学意义(P<0.05)。结论在下肢创伤病人中,S⁃FICB联合外侧入路坐骨神经阻滞与硬膜外麻醉相比,其血流动力学平稳、术后并发症少、病人舒适满意度高。Objective To explore the effect of ultrasound⁃guided supra⁃inguinal fascia iliaca compartment block(S⁃FICB)combined with lateral approach sciatic nerve block on postoperative rehabilitation of patients with lower extremity trauma.Methods A total of 100 patients with lower extremity trauma were selected and divided into groups by random number method,50 cases in the observation group receiving ultrasound⁃guided S⁃FICB combined with lateral approach sciatic nerve block,and 50 cases in the control group receiving L3/4 epidural anesthesia.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and ephedrine use were recorded before anesthesia(T0),10 min after anesthesia(T1),30 min after anesthesia(T2),and 60 min(T3).The anesthesia effect of the two groups,patient comfort satisfaction,nausea and vomiting during operation,nausea and vomiting and urinary retention within 48 h after operation were recorded.Results There was no statistically significant difference in anesthesia effect between the two groups(P>0.05).The preoperative comfort satisfaction was better,the consumption of ephedrine during the operation was lower,urinary retention and nausea 48 h after operation and the incidence of vomiting was significantly lower in the observation group than those in the control group,and the difference was statistically significant(P<0.05).Compared with T0,the SBP and DBP in the control group decreased significantly at T1 and T2(P<0.05).Compared with the observation group,the SBP in the control group decreased significantly at T1 and T2(P<0.05),and the DBP decreased significantly at T2(P<0.05).Conclusion In patients with lower extremity trauma,compared with epidural anesthesia,superior inguinal ligament iliaca space block combined with lateral approach sciatic nerve block can obtain stable hemodynamics,fewer postoperative complications,and higher patient comfort satisfaction.

关 键 词：腹股沟韧带上髂筋膜间隙阻滞 坐骨神经阻滞 外侧入路 超声引导 下肢创伤 

分 类 号：R614[医药卫生—麻醉学]