坐骨神经阻滞镇痛控制下肢血栓闭塞性脉管炎疼痛的临床观察

The clinical effect of sciatic nerve block on the pain of thromboangitis obliterans in lower limbs

目的观察坐骨神经阻滞对下肢血栓闭塞性脉管炎性疼痛的治疗效果。方法选择下肢动脉血栓闭塞性脉管炎伴下肢疼痛患者39例,随机分为氨酚羟考酮组(n=19)和神经阻滞组(n=20)。氨酚羟考酮组口服氨酚羟考酮(每片含325 mg对乙酰氨基酚+5 mg羟可酮),每日3次,每次1片,并根据疼痛缓解情况调整药物用量,每日最大剂量为8片/天。神经阻滞组应用神经刺激仪引导行患侧坐骨神经臀点穿刺,穿刺成功后置管,做皮下隧道,固定导管,并连接自控镇痛(PCA)泵。100 ml药盒内配制0.15%罗哌卡因溶液,电子泵设定参数:单纯自控镇痛(PCA)模式,8 ml/PCA,间隔时间30 min,每小时限量16 ml。治疗时间为两周。观察指标:①应用VAS镇痛评分评估镇痛效果。②采用Ramsay评分法评估镇静程度。③下肢皮温的变化。④头晕、恶心、呕吐、便秘等不良反应的发生率。结果①两组给药每日剂量均在药物安全适用范围,并氨酚羟考酮组高剂量组病例数占本组的52.6%;②治疗后,两组VAS疼痛评分值均较治疗前有明显降低,但在VAS≤3分组对比中,神经阻滞组所占比率明显高于氨酚羟可酮组,差异有统计学意义(P<0.05);③两组治疗前、后镇静评分比较显示,神经阻滞组治疗后均达到正常的镇静状态,而氨酚羟考酮组近30%患者处于浅睡眠状态,统计学比较差异有显著意义(P<0.05);④两组治疗前、后下肢循环改善情况比较,神经阻滞组治疗后皮温有显著性增高(P<0.05),而氨酚羟可酮组治疗后皮温无明显升高。⑤氨酚羟考酮组副作用的发生率明显高于神经阻滞组(P<0.05)。结论坐骨神经阻滞治疗下肢动脉血栓闭塞性脉管炎伴下肢疼痛患者神经镇痛效果确切,副作用发生率低,在安全性和对下肢循环影响等方面具有明显优势。

Objective To explorc the clinical effect of sciatic nerve block （SNB） on the pain of thrcmboangitis obliterans （TO） inlower limbs. Methods Thirty - nine patients with pain of TO in lower limbs were randomly divided into groups of receiving oxycedone ＆ acetaminophen tablets （OAT） （ OAT group, n = 19） and receiving patient controlled analgesia （PCA） via $NB （ SNB group, n = 20）. Patients in group OAT took orally OAT three times a day and one tablet every time. Each OAT tablet contained acetaminophen 325mg and oxycedone 5mg. The dose of OAT would be changed according to the analgesic effect and the limiting dose was 8 tablets a day. Patients in group SNB accepted sciatic nerve puncture in hip point and a catheter was placed for connecting with a PCA pump containing 0.15% rcpivacaine 100ml. The setting of PCA pump was a bolus of 0.15% ropivacalne 8 ml for one demand and the locking time was 30 minutes. The limiting dose was 16ml per hour. The treatment period was two weeks. Visual analogue scale （VAS）, Ramsay sedation score （RSS）, changes of temperature in lower limbs （CT）, and side effects such as dizziness, nausea, vomiting, and constipation were observed. Results The dose of medicine used in both groups was within the safe dose range. 52.6% patients in group OAT took the high dose of OAT. VAS before the treatment was significantly lower than that after the treatment in both groups （ P 〈 0. 05）. The percentage of patients with VAS less than 3 in group SNB was higher than that in group OAT （ P 〈 0.05 ）. The sedation state of patients in both groups was normal after the treatment but 30% patients in group OAT were a little sleepy （ P 〈 0. 05 ）. The temperature of lower limbs in group SNB was significantly increased after treatment （ P 〈 0. 05 ） and the temperature of low limbs in group OAT was not significantly changed after the treatment. Conclusion SNB would offer better analgesic effect and fewer side effects for patients with pain of TO and has more advantages in safety and improving the blood circulation in lower limbs.