超声引导下肢多神经联合阻滞在腘窝囊肿切除术中的应用

Ultrasound-guided application of multi-nerves combination blocking at legs in popliteal cyst surgery

目的:观察超声引导下闭孔神经、股神经、股外侧皮神经和坐骨神经联合阻滞在腘窝囊肿切除手术中的镇痛效果及安全性。方法:选择本院2014年1月至2016年2月期间行单侧腘窝囊肿切除手术的患者60例,通过随机数字表法随机分为两组:硬膜外麻醉组(epidural anesthesia,E组)30例和超声引导神经阻滞组(nerve blocking,N组)30例。于入室时、腘窝囊肿切除时、缝皮时分别监测患者平均动脉血压(mean arterial blood pressure,MAP)、心率(heart rate,HR),术中和术后2、4、6、10 h分别监测患者视觉模拟量表(visual analogue scale scores,VAS)评分,并监测两组术中血压下降及能够耐受止血带的病例数。结果:N组患者术中生命体征较E组更加平稳(P<0.05),N组能够耐受止血带的病例数明显多于E组(P<0.05),且N组术中没有患者发生低血压。术中及术后2 h两组患者VAS评分无明显差异(P>0.05),但术后4、6、10 h N组较E组明显降低(P<0.05)。结论:超声引导下多神经联合阻滞能够充分满足腘窝囊肿手术的麻醉要求,镇痛持续时间更长,更加安全有效。

Objective： To observe the analgesic effect and safety of the combination blocking of obturator nerve,femoral nerve,lateral femoral cutaneous nerve and sciatic nerve under ultrasound guidance in popliteal cyst surgery. Methods： Selection was arranged in 60 patients having unilateral popliteal cyst surgery during the period from January 2014 to February 2016. They were randomly divided into two groups via the random number table：Group E with epidural anesthesia（ 30 cases） and Group N with ultrasound-guided nerve blocking（ 30 cases）. Mean arterial pressure（ MAP） and heart rate（ HR） were monitored at the time spots of entrance into the operating room,popliteal cyst resection and skin suture. Visual analog scales（ VAS） scores were monitored in surgery and 2,4,6,10 hours after surgery. Meanwhile,The number of patients having hypotension with tolerance for tourniquet was recorded. Results： The vital signs of Group N was obviously less fluctuated versus Group E（ P 〈 0. 05）. The number of patients in Group N with tolerance of tourniquet was more than that in Group E（ P 〈 0. 05）,while no case of hypotension happened in Group N. There was no obvious difference for VAS scores in surgery and 2 hours after surgery between the two groups（ P 〉 0. 05）. However,VAS scores of Group N were obviously lower than Group E at the time spots of 4,6,10 hours after surgery（ P 〈 0. 05）. Conclusion： Ultrasound-guided multi-nerves combination blocking can fully meet the anesthesia requirements for popliteal cyst surgery with a longer duration of analgesia being safer and more effective.