超声引导下股神经阻滞联合坐骨神经阻滞对下肢静脉曲张患者围术期应激反应及术后疼痛影响  

Effects of ultrasound-guided femoral nerve block on perioperative stress response and postoperative pain in patients with lower e xtremity varicose veins

作　　者：张莹 王欣 徐宏伟[2] 陶凯[1] ZHANG Ying;WANG Xin;XU Hongwei;TAO Kai(Ultrasound Department,Meihekou Central Hospital,Meihekou,Jilin 135000,China;Department of Breast and Vascular Surgery,Meihekou Central Hospital,Meihekou,Jilin 135000,China)

机构地区：[1]梅河口市中心医院超声科,吉林梅河口135000 [2]梅河口市中心医院甲乳血管外科,吉林梅河口135000

出　　处：《手术电子杂志》2024年第6期19-23,29,共6页Electronic Journal of Medical Operations

摘　　要：目的 探讨超声引导下股神经阻滞联合坐骨神经阻滞对下肢静脉曲张患者围术期应激反应及术后疼痛的影响。方法 选取2018年10月—2022年6月期间梅河口市中心医院收治的102例行单侧大隐静脉曲张高位结扎剥脱术的患者,按照随机数字表法分为超声引导股神经阻滞联合坐骨神经阻滞组(N组,n=51)和蛛网膜下腔麻醉组(C组,n=51)。记录两组患者麻醉即刻、麻醉后5min、麻醉后20min、术毕即刻的收缩压(SBP)、舒张压(DBP)及心率(HR)水平,比较两组患者术后2h、4h、8h、12h、24h时间点静息下视觉模拟量表(VAS)评分,记录两组手术时间、阻滞起效时间、主动活动时间及术后不良反应发生情况。结果 两组麻醉后5 min、麻醉后20 min、术毕即刻的SBP、DBP、HR水平均低于麻醉即刻,差异有统计学意义(P<0.05);N组麻醉后5 min、麻醉后20 min、术毕即刻的SBP、DBP水平均高于C组,差异有统计学意义(P<0.05);两组麻醉后5 min、麻醉后20 min、术毕即刻的HR水平比较,差异无统计学意义(P>0.05)。两组8 h、12 h、24 h的VAS评分均高于术后2 h(P<0.05),N组术后2 h、4 h、8 h、12 h、24 h的VAS评分均低于C组,差异有统计学意义(P<0.05)。N组手术时间、主动活动时间明显短于C组,阻滞起效时间明显长于C组,差异有统计学意义(P<0.05)。N组术后恶心呕吐发生率明显低于C组,差异有统计学意义(P<0.05),两组术后皮肤瘙痒、尿潴留发生率比较,差异无统计学意义(P> 0.05)。结论 对下肢静脉曲张患者采用超声引导下股神经阻滞联合坐骨神经阻滞,有助于稳定术中血流动力学,降低围术期应激反应水平,提高术后镇痛效果,促进患者术后恢复,降低术后恶心呕吐发生率。Objective To investigate the effect of ultrasound-guided femoral nerve block combined with a sciatic nerve block on perioperative stress response and postoperative pain in patients with lower extremity varicose veins.Methods A total of 102 patients who underwent high ligation and stripping of unilateral great saphenous varices from October 2018 to June 2022 in Meihekou Central Hospital were selected and divided into two groups according to the random number table method:the ultrasound-guided femoral nerve block combined with a sciatic nerve block group(group N,n=51)and the subarachnoid anesthesia group(group C,n=51).The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of the two groups of patients were recorded immediately after anesthesia,5 minutes after anesthesia,20 minutes after anesthesia,and immediately after the operation.VAS scores at resting state at 2 h,4 h,8 h,12 h and 24 h after operation were compared.The operation time,block onset time,active activity time and postoperative adverse reactions were recorded in the two groups.Results SBP,DBP and HR in the two groups at 5 minutes after anesthesia,20 minutes after anesthesia,and immediately after the operation were lower than those immediately after anesthesia,and the differences were statistically significant(P<0.05).SBP and DBP of group N 5 minutes after anesthesia,20 minutes after anesthesia and immediately after operation were higher than those of group C,and the differences were statistically significant(P<0.05).There were no significant differences in HR 5 minutes after anesthesia,20 minutes after anesthesia and immediately after surgery between the two groups(P>0.05).The VAS scores at 8 h,12 h and 24 h in the two groups were higher than those at 2 h after operation(P<0.05).The VAS scores of group N at 2 h,4 h,8 h,12 h and 24 h after operation were significantly lower than those of group C,and the differences were statistically significant(P<0.05).The operation time and active activity time of group N were significantly s

关 键 词：股神经阻滞 超声 坐骨神经阻滞 下肢静脉曲张 应激反应 

分 类 号：R614[医药卫生—麻醉学]