超声定位股神经及坐骨神经阻滞在大隐静脉曲张高位结扎剥脱术中的应用

Application of ultrasound location of femoral nerve and sciatic nerve in patients undergoing varicose vein surgery

目的探讨超声定位股神经及坐骨神经阻滞在大隐静脉曲张手术中的应用效果。方法选取我院2016年9月至2017年3月行大隐静脉曲张手术患者40例,按照随机数字表法分为超声+神经阻滞组(N组)和蛛网膜下腔麻醉组(C组),每组20例。N组采用超声平面内联合神经刺激仪定位股神经及坐骨神经,C组采用蛛网膜下腔麻醉。比较2组术中麻醉效果、术中血流动力学变化,麻醉后2、4、6、12、24 h VAS评分及运动肌力分级,术后恶心、呕吐及尿潴留发生情况。结果 N组患者麻醉后2 h的VAS评分为0.10±0.31,C组为0.20±0.52,2组麻醉效果均可满足手术要求(P>0.05);N组感觉阻滞时间为(14.75±2.98)h,C组为(5.65±1.03)h,N组时间长于C组(P=0.003),且N组患者下肢运动肌力分级评分优于C组,2组差异有统计学意义(P<0.05)。结论超声平面内定位股神经及坐骨神经阻滞在大隐静脉曲张手术中应用效果显著,既可满足手术要求又可提供完善的术后镇痛;髋关节、膝关节、踝关节均可自主活动,减少患者术后下肢静脉血栓形成风险。

Objective To investigate the effect of ultrasound-guided femoral nerve and sciatic nerve in patients un- dergoing varicose vein surgery. Methods Forty cases undergoing varicose vein surgery were assigned into group N and group C （n=20 each） randomly. N group was given femoral nerve and sciatic nerve block under the guidance of ultrasound and nerve stimulator. C group was given spinal anesthesia. The anesthesia impacts, the changes of intraoperative hemodynamics were compared between the two groups. The VAS scores at 2 h, 4 h, 6 h, 12 h, 24 h after anesthesia, and the muscle strength classification were recorded. The complications of postoperative nausea, vomiting and retention of urine were observed. Results The VAS scores of N group 2 h after anaesthesia was 0.1±0.3, which was 0,2±0.5 in C group. Two groups of anesthesia could both meet the requirements during the operations （P 〉 0.05）. The sensory block time of N group was （ 14.75±2.98 ）h, which was （5.65±1.03）h in C group （P = 0.003）. The muscle strength classification of N group was better than C group. Conclusion The application of ultrasound guided femoral nerve and sciatic nerve has remarkable effect. It could not only meet the requirement of operation, but also provide perfect postoperative analgesia. The hip knee and ankle joint could move well after surgery. By reducing the risk of lower limb thrombosis, it deserves wide use in clinical practice.