超声引导下股神经联合腘窝坐骨神经阻滞在老年糖尿病患者手术中的应用研究

Study on ultrasound-guided combined femoral nerve-popliteal fossa and sciatic nerve block applied to elderly patients with diabetes mellitus

目的探讨超声引导下股神经联合侧入路腘窝坐骨神经阻滞在老年糖尿病患者膝关节及以下手术的应用效果。方法选取需行膝关节以下手术的老年糖尿病患者40例,随机分为A组和B组,每组20例。A组采用超声引导下股神经联合侧入路腘窝坐骨神经阻滞,B组采用椎管内麻醉。对比两组T0、T1、T2、T3时间点的平均动脉压(MAP)、心率(HR)以及视觉模拟评分(VAS)。结果 T0时,两组MAP、HR比较,差异均无统计学意义(P> 0. 05)。T1～T3时点,B组MAP、HR均显著高于同时间点的A组,差异均有统计学意义(P <0. 05)。B组术后首次下床活动时间为(3. 96±0. 67) d,明显长于A组的(2. 12±0. 45) d,差异有统计学意义(P <0. 05)。结论超声引导下股神经联合侧入路腘窝坐骨神经阻滞适用于老年糖尿病膝部及以下各类手术,不会造成神经干损害,无麻醉后遗症和并发症发生,值得临床推广应用。

Objective To investigate the efficacy of ultrasound-guided combined femoral nerve-lateral popliteal fossa sciatic nerve block in the elderly patients with diabetes mellitus during the surgery of knee joint and the parts below. Methods Forty elderly patients with diabetes mellitus who needed the surgery of knee joint and the parts below were enrolled,and were randomly divided into group A and group B,with 20 cases in each group. Group A received ultrasound-guided combined femoral nerve-lateral popliteal fossa sciatic nerve block,and group B received intraspinal anesthesia. At 4 time points（T0,T1,T2 and T3）,the mean arterial pressures（MAP）,heart rates（HR） and Visual Analogue Scale（VAS） scores were compared between the two groups. Results There were no significant differences in the MAP and HR at T0 between the two groups（P〉0. 05）. At T1-T3,the MAP and HR of group were significantly higher than those of group A（P〈0. 05）. The duration for postoperative first ambulation in group B was significantly longer than that in group A[（3. 96 ± 0. 67） d vs.（2. 12 ± 0. 45） d,P〈0. 05]. Conclusion Ultrasound-guided combined femoral nerve-lateral popliteal fossa sciatic nerve block is suitable for all kinds of surgery of knee joint and the parts below in the elderly diabetic patients,does not cause nerve trunk damage,anesthetic sequelae and complications,and is worthy of clinical promotion and application.