超声引导下隐筋膜间隙肿胀液麻醉在大隐静脉激光闭合术中的应用

Application of ultrasound-guided anesthesia of hidden fascia space swelling fluid in laser saphenous vein closure

目的探讨超声引导下隐筋膜间隙肿胀液麻醉在大隐静脉激光闭合术中的应用价值。方法选取行大隐静脉激光闭合术的患者60例,按随机数字表法分为观察组和对照组,每组30例,观察组在超声引导下分段穿刺隐筋膜间隙注入肿胀麻醉液配合芬太尼静脉清醒镇痛,对照组给予传统的腰麻,观察两组麻醉效果。结果两组阻滞起始时间和阻滞成功率比较差异均无统计学意义。麻醉后5 min阻滞感觉评分观察组高于对照组,差异有统计学意义(P<0.05),麻醉后15 min、25 min及30 min两组阻滞感觉评分差异均无统计学意义;观察组手术开始即刻心率高于对照组,差异有统计学意义(P<0.05),术前、术后15 min及术后30 min心率和平均动脉压两组间比较差异均无统计学意义;术后麻醉恢复即刻与术后2 h视觉模拟评分比较差异均无统计学意义,观察组术后4 h、6 h及8 h视觉模拟评分均低于对照组,差异均有统计学意义(均P<0.05),观察组和对照组术后6 h视觉模拟评分均最高,8 h后降低,差异均有统计学意义(均P<0.05)。结论超声引导下隐筋膜间隙肿胀液麻醉应用于大隐静脉激光闭合术加散在曲张静脉点式剥脱术中,安全、可靠、方便,尤其适合于单纯大隐静脉曲张患者,具有较好的临床应用价值。

Objective To explore the application value of ultrasound-guided anesthesia of hidden fascia space swelling fluid in laser saphenous vein closure.Methods Sixty patients who underwent selective saphenous vein laser closure were enrolled.The patients were divided into observation group and control group according to the random number table method,each group has 30 patients.In the observation group,saphenous vein laser closure proceeded under the guidance of ultrasound subcutaneous puncture in the interstitial space injection of swelling fluid anesthesia with fentanyl intravenous analgesia.The control group proceeded the traditional spinal anesthesia.The anesthetic effects of two groups were observed.Results There were no significant differences in the onset time of block and success rate of block between the two groups.The observation group was higher than the control group in block sensory scores 5 min after anesthesia（P 0.05）.There were no significant differences in block sensory scores of 15 min,25 min and 30 min after anesthesia between two groups.The heart rate of the observation group was significantly higher than that in control group at the beginning of the operation（P0.05）.There were no significant differences of heart rate and mean arterial pressure at preoperative and postoperative 15 min and 30 min between the two groups.There were no significant differences of visual analogue scale（VAS）at postoperative anesthesia immediate recovery and 2 h between two groups. The VAS of the control group was the highest at 6 h after operation and decreased after 8 h（all P0.05）.The VAS of the observation group were lower than those of the control group at 4,6 and 8 h after operation（all P0.05）.Conclusion Ultrasound-guided anesthesia of hidden space swelling fluid can be used to replace saphenous or femoral nerve anesthesia,and it is safe,reliable and convenient.It is especially suitable for patients with simple saphenous varicose veins,and has a good clinical application value.