仰卧位超声引导前入路与侧入路坐骨神经阻滞的临床效果比较

Effect of ultrasound-guided sciatic nerve block inthe supine position:anterior or lateral approaches

目的：比较患者仰卧位时超声引导下前入路与侧入路坐骨神经阻滞的临床效果。方法选择择期下肢远端手术患者60例，随机分为前入路进针组（A 组）和侧入路进针组（B 组），每组各30例。所有患者均先成功阻滞股神经。记录超声识别坐骨神经所用时间及穿刺所用时间，测量坐骨神经距体表的距离和穿刺针进针深度，评估阻滞完成后30 min 坐骨神经感觉和运动阻滞效果、术中麻醉效果及镇痛持续时间。结果 A 组患者超声识别坐骨神经所用时间[（27±8）s]短于 B 组[（34±9）s]，两组比较差异有统计学意义（P ＜0．05），坐骨神经距体表距离[（5．87±1．11）cm]小于 B 组[（6．84±0．97）cm]，两组比较差异均有统计学意义（P ＜0．05），但后者穿刺成功所用时间[（146±30）s]短于前者[（177±44）s]，且进针深度[（7．8±0．8）cm]也较前者短[（8．6±1．0）cm]，两组比较差异均有统计学意义（P ＜0．05）。阻滞完成后30min 时两组间坐骨神经感觉和运动阻滞效果、术中麻醉效果及镇痛持续时间比较差异均无统计学意义（P ＞0．05）。结论前入路进针有利于超声更快识别坐骨神经，侧入路进针能更快地到达坐骨神经。两种入路进针的麻醉效果无差别。在临床实践中应根据具体情况灵活选择超声探头位置和进针入路。

Objective To compare the effects of anterior and lateral approaches on ultrasound-guided sciatic nerve block for patients inthe supine position.Methods Sixty patients undergoing lower limb surgery were randomly divided into two groups to receive ultrasound-guided sciatic nerve block via anterior（Group A）or lateral（Group B）approaches in the middle thigh after femoral nerve block.Ultra-soundidentification time of the sciatic nerve,distance of the sciatic nerve to skin,the piercing time,and depth of the inserted needle were recorded to compare in two groups.Quality of sciatic nerve block at 30 minutes after injection,effects of anesthesia and duration of nerve block were assessed.Results Ultra-soundidentification time of the sciatic nerve was shorter[（27 ±8）s vs（34 ±9）s]and the sciatic nerve was closer to skin [（5.87 ±1 .1 1 ）cm vs（6.84 ±0.97）cm]in Group A（P 〈0.05）.However,the piercing time was longer [（1 77 ±44）s vs（1 46 ±30）s]and depth of the inserted needle [（8.6 ±1 .0）cm vs （7.8 ±0.8）cm]was deeper than those in group B（P 〈0.05）.There were no significant differences in quality of nerve block,effects of anesthesia,and duration of nerve block.Conclusion The anterior ap-proach is easier to identify the sciatic nerve,while the lateral approach is more convenient to pierce in the supine position.There isno obvious difference in nerve block between the two approaches.Ultrasonic probe location and approaches can be chosen flexibly according to the actual situation.