全身麻醉和神经阻滞在糖尿病足患者截趾术中的应用效果比较

Compare the Effects of General Anesthesia and Nerve Block in the Application of Toe Amputation in Patients with Diabetic Foot

目的比较全身麻醉和神经阻滞在糖尿病足患者截趾术中的应用效果。方法选取2017年4月至2020年1月于青岛市市立医院就诊并接受择期截趾术治疗的60例糖尿病足患者。将术中接受全身麻醉的30例患者纳入GA组。将术中接受神经阻滞的30例患者纳入NB组。对GA组患者行常规诱导。在B超引导下,对NB组患者行腓总神经、胫神经和股神经阻滞。比较两组手术开始前5 min(T_(0))、切皮时(T_(1))、手术刚结束时(T_(2))、术后3 h(T_(3))、术后6 h(T_(4))和术后12 h(T_(5))的平均动脉压(MAP)、心率(HR)。分别于术后3、6、12 h采用视觉模拟量表(VAS)评估患者的疼痛程度。比较两组外科医生满意度、患者满意度、住院时间和住院费用。结果T_(3)、T_(4),NB组MAP和VAS评分低于GA组,NB组HR慢于GA组(P<0.05)。两组外科医生满意度比较,差异无统计学意义(P>0.05)。两组患者满意度比较,差异无统计学意义(P>0.05)。NB组术后住院时间短于GA组,住院费用低于GA组(P<0.05)。结论在糖尿病足患者截趾术中,神经阻滞能够改善患者术后的疼痛感,减少住院费用,缩短住院时间。

Objective To compare the effects of general anesthesia and nerve block in the application of toe amputation in patients with diabetic foot.Methods A total of 60 patients with diabetic foot who were treated at Qingdao Municipal Hospital from April 2017 to January 2020 and received elective toe amputation were selected.Thirty patients who received general anesthesia during the operation were included in GA group.Thirty patients who received nerve block during the operation were included in NB group.Routine induction was performed on patients in GA group.The block of common peroneal nerve,tibial nerve and femoral nerve were performed on patients in NB group under the guidance of B-ultrasound.Mean arterial pressure(MAP)and heart rate(HR)were compared between the two groups at 5 minutes before operation(T_(0)),skin cutting(T_(1)),immediately after operation(T_(2)),3 hours after operation(T_(3)),6 hours after operation(T_(4))and 12 hours after operation(T_(5)).Visual analogue scale(VAS)was used to evaluate the pain degree of the patients at 3,6,and 12 hours after operation.The surgeons’satisfaction,patients’satisfaction,hospitalization time and hospitalization expenses were compared between the two groups.Results At T_(3) and T_(4),MAP and VAS scores in NB group were lower than those in GA group,and HR in NB group was slower than that in GA group(P<0.05).There was no statistical difference in surgeons’satisfaction between the two groups(P>0.05).There was no statistical difference in patients’satisfaction between the two groups(P>0.05).The hospitalization time after operation in NB group was shorter than that in GA group,and hospitalization expenses in NB group was lower than that in GA group(P<0.05).Conclusion In the toe amputation in patients with diabetic foot,nerve block could improve postoperative pain,reduce hospitalization expenses and shorten hospitalization time.