超声引导或传统解剖定位下区域阻滞在踝关节手术麻醉中的应用效果比较

Comparative study of ultrasound guided vs.classic anatomical regional block anesthesia for ankle operation

目的 探讨超声引导或传统解剖定位下坐骨神经加股神经阻滞麻醉的应用效果.方法 择期行踝关节手术患者60例,采用随机数字表法,将患者随机分为2组（n=30）：对照组（A组）和观察组（B组）,每组30例.对照组采取传统解剖定位穿刺下行坐骨神经加股神经阻滞麻醉,观察组采取超声引导下行坐骨神经加股神经阻滞麻醉.对两组患者麻醉完成时间、感觉阻滞与运动阻滞效果、镇痛持续时间、穿刺或调整针头方向次数、不良反应及并发症的发生进行比较.结果 观察组麻醉完成时间与对照组比较差异无统计学意义（P＞0.05）;观察组T2～ T3时坐骨神经感觉和运动阻滞程度分别为：1.84±0.16、2.45±0.27,1.52 ±0.09、1.30 ±0.12;股神经感觉和运动阻滞程度分别为：1.91 ±0.20、2.46±0.47、1.49 ±0.10、1.03 ±0.19,与对照组比较感觉与运动阻滞效果明显,两组比较差异有统计学意义（P＜0.05）;观察组在24 h时VAS评分为（2.64±0.28）分、穿刺或调整针头方向次数为2.69±0.76,不良反应与并发症发生例数均显著低于对照组（P＜0.05）.结论 超声引导下坐骨神经加股神经阻滞麻醉较传统解剖定位阻滞麻醉效果更确切、安全性高,较传统阻滞方法优越.

Objective To compare the effect between ultrasound guided or classic anatomical sciatic-femoral nerve block anesthesia.Methods Sixty patients who would accept ankle operation were divided to two groups randomly according to random number table：control group （group A,n =30） and observation group （group B,n =30）.Patients in group A received classic anatomical sciatic-femoral nerve block anesthesia,and those in group B were given ultrasound-guided sciatic-femoral nerve block anesthesia.In this study,time before analgesia,effect of sensory and motor block,duration of analgesia,frequency of puncture or adjusting the direction of the needles,adverse reaction and complications were recorded and compared.Results There was no statistically significant difference in time before analgesia between the two groups （P 〉 0.05）.The effects of sensory and motor block of sciatic nerve in the observation group at T2-T3 were 1.84 ± 0.16 and 2.45 ± 0.27,and 1.52 ± 0.09 and 1.30 ± 0.12,and those of femoral nerve were 1.91 ±0.20,2.46 ±0.47,1.49 ±0.10 and 1.03 ±0.19,respectively.There was significant difference between two groups （P 〈 0.05）.In the observation group at 24 h,the VAS scores were 2.64 ±0.28,frequency of puncture or adjusting the direction of the needles was 2.69 ± 0.76,and number of adverse reactions and complications were significantly reduced as compared with those in the control group （P 〈 0.05）.Conclusion Ultrasound-guided sciatic-femoral nerve block anesthesia was more effective and safer than classic anatomical sciatic-femoral nerve block anesthesia.