股神经联合坐骨神经阻滞用于大隐静脉曲张剥脱术的临床效果评价

Clinical Evaluation of Femoral Nerve Block with Sciatic Nerve Block for Stripping in Treatment of Great Saphenous Varicose Vein

目的:观察股神经联合坐骨神经阻滞用于大隐静脉剥脱术的麻醉效果。方法:选择大隐静脉剥脱术患者60例,采用随机数字表法分为两组,N组:B超联合神经刺激仪引导股神经、坐骨神经阻滞,E组:L3-4间隙行腰-硬联合麻醉。比较两组患者麻醉效果,术后6h(T0)、12h(T1)、24h(T2)、48h(T3)镇痛效果,恶心呕吐、尿潴留发生率,首次下床活动时间及感觉阻滞维持时间。结果:两组患者麻醉效果比较,E组Ⅰ级比例显著高于N组(P<0.05),Ⅱ级比例显著低于N组(P<0.05),但麻醉优良率差异无统计学意义(P>0.05);VAS评分T1、T2时间点N组显著低于E组(P<0.05);恶心、尿潴留发生率N组显著低于E组(P<0.05);首次下床活动时间N组显著早于E组(P<0.05),感觉阻滞维持时间N组显著长于E组(P<0.05)。结论:股神经联合坐骨神经阻滞用于大隐静脉曲张剥脱术,具有麻醉及术后镇痛效果确切、并发症少、利于早期下床活动等优点,值得临床推广应用。

Objective: To observe the anesthetic effects of femoral nerve combined with sciatic nerve block in saphenous vein exfoliation. Methods: Sixty patients with great saphenous vein exfoliation were selected and randomly divided into two groups with 30 cases in each group. Group N: Femoral nerve and sciatic nerve block guided by B-ultrasound combined with nerve stimulator. Group E: Spinal-epidural Anesthesia at L3-4 Interstitial. Anesthetic effects between two groups were compared in the analgesia at 6h(T0)、12h(T1)、24 h(T2)、48h(T3) after operation, incidence of nausea, vomiting and uroschesis, first time of get out of bed, cost of anesthesia. Results: In comparison of anesthetic effects between two groups, the proportion of grade I in group E was significantly higher than that in group N(P<0.05) and grade II was significantly lower than group N(P<0.05), but there was no significant difference of excellent-good rate of anesthesia (P>0.05). The VAS score of group N was significantly lower than that of group E at T1 and T2 time points(P<0.05). The incidence of nausea and urinary retention in group N was significantly lower than that in group E(P<0.05). The first time of getting out of bed in group N was significantly lower than that in group E (P<0.05). The maintenance time of sensory block in group N was significantly longer than that in group E(P<0.05).Conclusion: Femoral nerve block combined with sciatic nerve block for the stripping of great saphenous vein appeared the advantages with exact effects in anesthesia and postoperative analgesia, fewer complications, early ambulation and less anesthesia cost, which was suitable for clinical application.