超声引导下前路腰丛联合坐骨神经阻滞在大隐静脉高位结扎加剥脱术中麻醉效果观察  

Anesthetic effect of ultrasound-guided anterior lumbar plexus combined with sciatic nerve block in high ligation and stripping of great saphenous vein

作　　者：苗楚涵 吕洁萍[2] 石瑞芬 杨玲[1] Miao Chuhan;Lyu Jieping;Shi Ruifen;Yang Ling(School of Anesthesiology,Shanxi Medical University,Taiyuan 030000,Shanxi,China;Department of Anesthesiology,The First Hospital of Shanxi Medical University,Taiyuan 030000,Shanxi,China)

机构地区：[1]山西医科大学麻醉学院,太原030000 [2]山西医科大学第一医院麻醉科,太原030000

出　　处：《中国现代手术学杂志》2023年第3期226-231,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的观察超声引导下前路腰丛联合坐骨神经阻滞在单侧大隐静脉高位结扎加剥脱术中的麻醉效果。方法选择山西医科大学第一医院拟行单侧大隐静脉高位结扎加剥脱术的大隐静脉曲张患者60例,男34例,女26例,年龄30~80岁,BMI 18~30 kg/m^(2),ASAⅠ~Ⅲ级,随机分为两组:N组(n=30)行超声引导下前路腰丛阻滞联合坐骨神经阻滞,先给予0.375%罗哌卡因15 mL行坐骨神经阻滞,后给予0.375%罗哌卡因35 mL行前路腰丛阻滞;E组(n=30)行腰麻,给予0.67%重比重罗哌卡因2.5~3 mL。观察并记录两组入室后(T0)、麻醉后15 min(T1)、切皮(T2)、剥脱静脉(T3)、术毕(T4)以及术后4 h(T5)、8 h(T6)、12 h(T7)、24 h(T8)时静息疼痛视觉模拟评分(VAS),追加舒芬太尼总量、血管活性药使用例数,观察T0、T1、T2、T3、T4时平均动脉压(MAP)、心率(HR)变化及评估术者对于麻醉效果的满意度。记录术后24 h内并发症(头痛、尿潴留、相关神经并发症、恶心呕吐)发生情况。结果组内与T0时比较,N组T1、T4时HR降低,T4时MAP降低,E组T1、T4时HR降低,T2时升高,T1、T3和T4时MAP降低,两组T1~T8静息VAS评分均降低,差异均有统计学意义(P<0.05),而其余时间点组内比较差异均无统计学意义(P>0.05)。与E组相比,N组T1、T4时HR加快,T1、T3时MAP升高(P<0.05),T4~T7时静息VAS评分明显降低,差异均有统计学意义(P<0.05),而其余各时间点组间比较差异均无统计学意义(P>0.05)。N组使用血管活性药物总例数明显少于E组,而术者满意度高于E组(P<0.05);两组舒芬太尼追加量及术后24 h并发症发生率比较,差异均无统计学意义(P>0.05)。结论单侧大隐静脉高位结扎加剥脱术中应用前路腰丛联合坐骨神经阻滞,麻醉效果确切,患者血流动力学参数平稳,能满足术者要求,术后不良反应少,值得在临床中推广。Objective To observe the anesthetic effect of ultrasound-guided anterior lumbar plexus block combined with sciatic nerve block in unilateral high ligation and stripping of great saphenous vein.Methods Sixty patients of great saphenous vein varicose,34 males and 26 females,aged 30 to 80 years old,BMI 18 to 30 kg/m^(2),ASAⅠtoⅢ,were selected and randomly divided into two groups with 30 cases for each group.Group N received ultrasound-guided anterior lumbar plexus block combined with sciatic nerve block,first administration with 15 mL of 0.375%ropivacaine for sciatic nerve block,and then with 35 mL of 0.375%ropivacaine for anterior lumbar plexus block.Group E underwent lumbar anesthesia with administration of 0.67%ropivacaine 2.5 to 3 mL.The resting visual analogue scale(VAS)of both groups were observed and recorded after entry(T0),15 minutes after anesthesia(T1),skin resection(T2),vein stripping(T3),end of the operation(T4),4h(T5),8h(T6),12h(T7)and 24h(T8)after the surgery.Additional dosage of sufentanil,the cases of vasoactive drugs administration and surgeon's satisfaction with the anes-thesia effect were recorded.The changes of mean arterial pressure(MAP)and heart rate(HR)at T0,T1,T2,T3 and T4 were observed.Post-operative complications including headache,urinary retention,related neurological complications,nausea and vomiting were recorded within 24 hours after the opera-tion.Results Compared with T0:HR was decreased at T1 and T4 and MAP was decreased at T4 in group N(P<0.05),and HR was decreased at T1 and T4,increased at T2,and MAP was decreased at T1,T3 and T4 in Group E(P<0.05);The resting VAS scores of T1 to T8 were decreased in both groups(P<0.05);There was no statistical difference at other time points(P>0.05).Compared with group E,HR was accelerated at T1 and T4,MAP was increased at T1 and T3,and resting VAS score was significantly decreased at T4 to T7 in group N(P<0.05),and there was no statistically significant differ-ence at the remaining time points between the two groups(P>0.05).The total numbers

关 键 词：前路腰丛阻滞 坐骨神经阻滞 超声引导 

分 类 号：R614[医药卫生—麻醉学]