超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果

Anesthesia effect of anterior approach sciatic and femoral nerve block ultrasound-guided combined with nerve stimulator in diabetic foot surgery

目的观察超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果。方法选取择期行糖尿病足手术患者80例,随机分为坐骨神经及股神经阻滞组(PF组)和单次蛛网膜下腔阻滞组(SA组),每组40例。观察2组患者麻醉前(Tb)以及麻醉后5(T5)、10(T10)、15(T15)、30(T30)min的心率、收缩压及舒张压。观察2组患者感觉神经阻滞的起效时间(T1)、完全阻滞时间(T2)及完全消退时间(T3),术后首次排尿时间(Tm)。比较2组患者术后6、12、18、24 h的疼痛视觉模拟量表(VAS)评分。观察2组患者麻醉满意度,麻醉不良反应、并发症发生情况。结果血流动力学指标比较:2组Tb的收缩压、舒张压、心率比较差异均无统计学意义(均P>0.05),SA组在T5、T10、T15、T30的收缩压、舒张压较Tb下降(均P<0.05),且低于PF组T5、T10、T15、T30(均P<0.05)。PF组T1、T2、T3长于SA组(均P<0.05),Tm短于SA组(P<0.05)。PF组术后12、18、24 h VAS评分低于SA组(均P<0.05)。SA组与PF组不良反应发生率分别为72.5%、7.5%,组间比较差异有统计学意义(P<0.05)。结论超声联合神经刺激仪引导下前入路坐骨神经及股神经阻滞在糖尿病足手术中的麻醉效果确切,血流动力学稳定,且不良反应少,患者满意度高。

Objective To observe the anesthetic effect of anterior approach sciatic nerve and femoral nerve block in diabetic foot surgery ultrasound-guided combined with neurostimulator.Methods Eighty patients with elective diabetic foot surgery were randomly divided into sciatic nerve and femoral nerve block group(PF group)and single subarachnoid block group(SA group),40 cases in each group.The heart rate,systolic blood pressure and diastolic blood pressure of the two groups before the anesthesia(Tb)and 5(T5),10(T10),15(T15),30(T30)min after anesthesia were observed.The onset time(T1),complete block time(T2)and complete regression time(T3)of the sensory nerve block in the 2 groups,the first urinary time(Tm)were performed.The pain visual analogue scale(VAS)scores at 6,12,18,and 24h after surgery were compared between the 2 groups.The anesthesia satisfaction,anesthetic adverse reactions and complications were observed in the 2 groups.Results Comparison of hemodynamic:there was no statistical difference in systolic blood pressure,diastolic blood pressure and heart rate of Tb between the two groups(P>0.05).The systolic and diastolic blood pressures of T5,T10,T15 and T30 were decreased compared with Tb in SA group(P<0.05)and was lower than T5,T10,T15,T30 of PF group(P<0.05).T1,T2 and T3 of group PF were longer than group SA(both,P<0.05),Tm was shorter than group SA(P<0.05),The VAS scores of the PF group were lower than those of the SA group at 12,18,and 24h after operation(P<0.05).Incidence of adverse reactions was 72.5%in SA group and7.5%in PF group,there was a significant difference between two groups(P<0.05).Conclusion The anesthetic effect of anterior approach sciatic nerve and femoral nerve block in diabetic foot surgery ultrasound-guided combined with neurostimulator is accurate,hemodynamics is stable,less adverse reactions,high patient satisfaction.