超声引导下髂筋膜联合坐骨神经阻滞对下肢血运重建患者术后主要心血管不良事件的影响  

Effect of ultrasound-guided iliac fascia combined with sciatic nerve block on major cardiovascular adverse events in patients undergoing lower limb revascularization surgery

作　　者：刘曼曼 熊万霞 应美晶 梁超 丁明 LIU Manman;XIONG Wanxia;YINGMeijing;LIANG Chao;DING Ming(Department of Anesthesiology,Zhongshan Hospital,Fudan University(Xiamen Branch),Xiamen 361000,China;不详)

机构地区：[1]复旦大学附属中山医院厦门医院麻醉科,福建厦门361000 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《实用医学杂志》2024年第11期1531-1536,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81801376)。

摘　　要：目的评价超声引导下髂筋膜联合坐骨神经阻滞对下肢ASO患者血运重建术后主要心血管不良事件和预后的影响。方法选择性下肢血运重建手术ASO患者353例。根据术中采取不同的麻醉方式将患者分为两组:超声引导下髂筋膜联合坐骨神经阻滞组(B组)和手术监测麻醉(MAC)(M组);主要观察指标:ASO患者行下肢血运重建术后的主要心血管不良事件(MACE)发生率。次要观察指标:非心脏术后心肌损伤(MINS)、术后截肢、其他不良反应(如术后谵妄、恶心呕吐等)的发生率、术后实验室指标。通过倾向性得分匹配平衡术前基线,对匹配后的数据分析不同麻醉方式对下肢ASO患者血运重建术后MACE和预后的影响。结果在倾向性得分匹配后,与M组相比,B组的MACE发生率更低(10%vs.3.4%,P=0.038);B组的MINS发生率(33%vs.25%,P=0.200);B组的截肢率(4.2%vs.3.4%,P>0.99);B组的并发症发生率为(6.8%vs.4.2%,P=0.39);两组术后实验室指标差异无统计学意义(P>0.05)。多因素分析显示神经阻滞(OR=0.25,95%CI:0.05~0.93)、术后HBG(OR=0.95,95%CI:0.91~0.99)是降低MACE发生的保护。结论超声引导下髂筋膜联合坐骨神经阻滞可以降低下肢ASO患者血运重建术后发生MACE的风险。Objective To assess the impact of ultrasound-guided fascia iliaca compartment block on major cardiovascular events and postoperative prognosis in patients with lower limb aortoiliac occlusive disease(ASO).Methods This study was a retrospective study including 353 patients with lower limb arterial reconstruction surgery for ASO at Xiamen Hospital Affiliated to Zhongshan Hospital of Fudan University from January 2018 to January 2022.Patients were divided into two groups based on different anesthesia:the group receiving ultrasound-guided fascia iliaca block combined with sciatic nerve block(Group B)and the group receiving monitored anesthesia care(MAC)(Group M).The primary outcome was the occurrence of major adverse cardiovascular events after lower limb arterial reconstruction surgery in ASO patients.The secondary outcomes included the incidence of non-cardiac postoperative myocardial injury,postoperative amputation,and other adverse reactions such as postoperative delirium,nausea,and vomiting as well as postoperative laboratory indicators.By using propensity score matching to balance baseline characteristics before surgery,the impact of different anesthesia methods on the occurrence of MACE and prognosis after surgery in ASO patients was analyzed.Results After propensity score matching,the incidence of MACE in Group B was lower compared with Group M(10%vs.3.4%,P=0.038);The incidence of MINS in Group B(33%vs.25%,P=0.200);The amputation rate of Group B(4.2%vs.3.4%,P>0.99);The incidence of complications in Group B was(6.8%vs.4.2%,P=0.39);There was no statistically significant difference in postoperative laboratory indicators between the two groups(P>0.05).Multivariate analysis showed that nerve block(OR=0.25,95%CI:0.05~0.93),postoperative HBG(OR=0.95,95%CI:0.91~0.99)were independent factors in reducing the incidence of MACE.Conclusion Ultrasound-guidance fascia iliaca compartment block and sciatic nerve block could reduce the risk of major adverse cardiovascular events in patients undergoing lower limb arterial revas

关 键 词：髂筋膜 坐骨神经阻滞 主要心血管不良事件 倾向性得分匹配 

分 类 号：R614[医药卫生—麻醉学]