超声引导下腹股沟上髂筋膜阻滞在股前外侧皮瓣移植手术中的风险-效益评价  

Risk-benefit evaluation of ultrasound-guided abdominal thigh superior iliac fascia block in anterolateral thigh flap transplantation

作　　者：季加伟 刘艳[2] 王猛[3] 芮永军[4] JI Jiawei;LIU Yan;WANG Meng;RUI Yongjun(Medical Science Center of Soochow University,Suzhou 215123,Jiangsu,China;Department of Anesthesiology,The Affiliated Hospital of Jiangnan University,Wuxi 214122,Jiangsu,China;Department of Anesthesiology,Wuxi Ninth Hospital,Soochow University,Wuxi 214000,Jiangsu,China;Department of Traumatic Orthopedics,Wuxi Ninth Hospital,Soochow University,Wuxi 214000,Jiangsu,China)

机构地区：[1]苏州大学医学部,江苏苏州215123 [2]江南大学附属医院麻醉科,江苏无锡214122 [3]苏州大学附属无锡九院麻醉科,江苏无锡214000 [4]苏州大学附属无锡九院创伤骨科,江苏无锡214000

出　　处：《西部医学》2023年第11期1662-1668,共7页Medical Journal of West China

摘　　要：目的 基于多准则决策模型评价超声引导下腹股沟上髂筋膜阻滞在股前外侧皮瓣移植手术中的风险-效益。方法 选取2018年12月—2020年9月于苏州大学附属无锡九院行股前外侧皮瓣移植手术的患者98例,采用随机数字表法分为对照组和观察组,每组49例。对照组行全身麻醉,观察组于全身麻醉诱导前20 min行腹股沟上髂筋膜阻滞。对比两组患者一般资料、手术情况、术中麻醉药物用量、术后视觉模拟评分法(VAS)评分、麻醉恢复室(PACU)停留时间、术后镇痛泵按压次数、术后镇痛满意度评分及术后住院时间,并对比两组不良发反应发生情况。建立超声引导下腹股沟上髂筋膜阻滞在股前外侧皮瓣移植手术中的效益与风险多准则决策(MCDM)分析模型,采用RevMan5.3软件合并数据,得出各效益指标和风险指标效应值,采用Hiview3软件计算出两组的效益值、风险值和效益-风险总值,改变效益-风险中一级指标的权重来并评价模型的灵敏度。结果 与对照组比较,观察组术中舒芬太尼和丙泊酚用量显著降低,术后4、8、12 h的静息VAS评分明显降低,PACU停留时间、术后镇痛泵按压次数及术后住院时间明显减少,术后不良反应发生率明显降低,术后镇痛满意度评分明显增加(均P<0.05)。与对照组比较,观察组的效益高、风险低,当效益和风险都重要时,观察组、对照组的效益-风险总值分别为71、58,且观察组100%优于对照组,MCDM评价模型的稳定性较好。结论 与传统全身麻醉相比,超声引导下腹股沟上髂筋膜阻滞在股前外侧皮瓣移植手术中的获益高于风险,且效益-风险更优,可用于股前外侧皮瓣移植手术镇痛。Objective To evaluate the risk-benefit of ultrasound-guided abdominal thigh superior iliac fascia block in anterolateral thigh flap transplantation based on multi criteria decision-making model.Methods 98 patients who underwent anterolateral thigh flap transplantation in Wuxi Ninth Hospital from December 2018 to September 2020 were randomly divided into control group(49 cases)and observation group(49 cases).The patients in the control group received general anesthesia,and the patients in the observation group received groin superior iliac fascia block 20 minutes before the induction of general anesthesia.The general information,operation conditions,intraoperative anesthetic dosage,postoperative VAS score,PACU residence time,press times of postoperative analgesia pump,postoperative analgesia satisfaction score and postoperative hospitalization time of the two groups were compared,and the adverse reactions of the two groups were compared.Established under the guidance of ultrasound on the groin iliac fascia block in the femoral anterolateral flap transplant benefit and risk a multicriteria decision analysis model,combined with RevMan5.3 software data,it is concluded that the effects of efficiency index and risk index value,using Hiview3 software to calculate the efficiency value of the observation group and control group,risk value and benefit/risk,The sensitivity of the model was evaluated by changing the weight of the first-level index in benefit-risk.Results Compared with the control group,the dosage of sufentanil and propofol in the observation group decreased significantly during operation,and the resting VAS score decreased significantly at 4,8 and 12 hours after operation,PACU,residence time,press times of postoperative analgesia pump and postoperative hospital stay shortened obviously,significantly lower incidence of postoperative adverse reactions,postoperative analgesia satisfaction score increased significantly.The differences were statistically significant(P<0.05).Compared with the control group,the ben

关 键 词：髂筋膜阻滞 股前外皮瓣移植 围术期镇痛 风险 效益 多准则决策模型 

分 类 号：R614[医药卫生—麻醉学] R64[医药卫生—外科学]