超声引导下腰交感神经阻滞在下肢皮瓣修复手术中的应用

Ultrasound-guided lumbar sympathetic block for flap repair of lower limb defects

目的探讨腰交感神经阻滞(LSB)在下肢皮瓣缺损修复术中的应用效果。方法回顾性分析2017年6月至2018年12月湛江中心人民医院麻醉科接受下肢皮瓣修复手术治疗的27例下肢皮瓣缺损患者资料。根据治疗方式不同分为对照组(接受常规皮瓣修复术治疗,14例)和LSB组(在对照组基础上给予腰交感神经阻滞,13例)。观察两组患者术后12、24、48、72 h的皮瓣颜色、质地、皮温、皮瓣存活情况、疼痛视觉模拟评分(VAS)以及随访1个月后植皮区感觉恢复情况。结果对照组和LSB组下肢皮瓣缺损患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获2~6个月(平均3.1个月)随访。术后12、24 h LSB组在皮瓣颜色正常患者比例(84.6%、92.3%)明显高于对照组(35.7%、50.0%),差异均有统计学意义(P<0.05)。LSB组术后72 h之内的皮肤温度[(36.7±0.2)、(36.8±0.3)、(36.9±0.2)、(36.9±0.1)℃]高于对照组[(35.4±0.4)、(35.7±0.6)、(35.9±0.3)、(36.2±0.2)℃],差异均有统计学意义(P<0.05)。术后48、72 h LSB组皮瓣血供良好患者比例(92.3%、100.0%)高于对照组(50.0%、57.1%),差异均有统计学意义(P<0.05)。术后12、24 h LSB组患者VAS评分[(2.1±1.0)、(2.3±0.9)分]低于对照组[(4.6±0.9)、(4.4±0.8)分],差异均有统计学意义(P<0.05)。LSB组13例患者皮瓣均一期手术后正常存活,对照组1例发生感染。随访1个月后LSB组皮瓣感觉恢复患者共12例(92.3%),对照组皮瓣感觉恢复患者6例(42.9%),差异有统计学意义(P<0.05)。结论LSB作为下肢皮瓣修复手术的辅助治疗,能够改善患者移植皮瓣的血供情况,有利于移植皮瓣区感觉神经功能的恢复。

Objective To evaluate the efficacy of ultrasound-guided lumbar sympathetic block (LSB) used for flap repair of lower limb defects. Methods A retrospective study was conducted of the 27 patients who had received flap repair of lower limb defects at Department of Anesthesiology, Central People’s Hospital of Zhanjiang surgery from June 2017 to December 2018. Of them, 14 had conventional flap repair (conventional group) and 13 additional ultrasound-guided LSB (LSB group). The 2 groups were compared at 12, 24, 48 and 72 hours after operation in terms of color, texture, skin temperature and survival of the flaps and visual analogue scale (VAS) pain scores. Functional recovery of flap sensation after one month follow-up was also observed and compared. Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data(P>0.05). All the patients were followed up for an average of 3.1 months (from 2 to 6 months). At 12 and 24 hours after operation, the LSB group had significantly more patients with normal flap color (84.6% and 92.3%) than the conventional group (35.7% and 50.0%)(P<0.05). At 12, 24, 48 and 72 hours after operation, the LSB group had significantly higher skin temperature (36.7±0.2 ℃, 36.8±0.3 ℃, 36.9±0.2 ℃ and 36.9±0.1 ℃) than the conventional group(35.4±0.4 ℃, 35.7±0.6 ℃, 35.9±0.3 ℃ and 36.2±0.2 ℃)(P<0.05). At 12 and 24 hours after operation, the LSB group had significantly lower VAS pain scores (2.1±1.0 and 2.3±0.9) than the conventional group(4.6±0.9 and 4.4±0.8)(P<0.05). All the flaps in the LSB group obtained primary survival after operation while infection occurred in one case in the conventional group. One month follow-up showed that 12 patients in the LSB group (92.3%) obtained sensory recovery of flaps while 6 ones (42.9%) did in the conventional group, showing a significant difference (P<0.05). Conclusion As an auxiliary treatment for flap repair of lower limb defects, SLB can improve the blood supply to the transplanted flap and facilitate the recovery of nerve function in the graft flap.