基于超声引导的改良前路坐骨神经阻滞在全麻骨科手术中的应用效果

The Effect of Modified Anterior Sciatic Nerve Block Guided by Ultrasound in General Anesthesia and Orthopedic Surgery

目的:分析改良前路坐骨神经阻滞用于全麻骨科手术作用。方法:选择在本院进行骨科全麻手术的93例病患为研究样本,其手术时间均在2018年3月-2019年3月,采取随机数字排列表法将其分成A组(31例)、B组(31例)以及C组(31例)。予以A组病患前入路麻醉,予以B组病患后入路麻醉,予以C组病患改良前入路麻醉。全部病患均在坐骨神经阻滞完成后实施股神经阻滞,当到达手术所需麻醉平面后,予以病患静吸复合麻醉,直至手术完成。比较3组病患进针深度、坐骨神经阻滞操作时间、坐骨神经阻滞持续时间、坐骨神经深度以及舒芬太尼使用剂量;观察3组病患麻醉效果;比较3组病患超声图像清晰度得分。结果:B组病患进针深度、坐骨神经深度均小于A组和C组,坐骨神经阻滞操作时间均短于A组和C组,但坐骨神经阻滞持续时间均长于A组和C组,并且舒芬太尼使用剂量均低于A组和C组(P<0.05)。B组病患麻醉总有效率低于A组(P<0.05),C组病患麻醉总有效率低于B组且高于A组,但比较无显著差异(P>0.05)。C组病患超声图像清晰度得分高于A组和B组(P<0.05)。结论:后入路阻滞进针深度、坐骨神经深度、坐骨神经阻滞操作时间、坐骨神经阻滞持续时间以及舒芬太尼使用剂量均优于前入路阻滞以及改良前入路阻滞,超声引导下改良前路坐骨神经阻滞在全麻骨科手术阻滯效果方面不如后入路阻滞效果,并且与常规前入路阻滞效果差异不大,但其操作简便,并且超声图像清晰度较高,在临床全麻骨科手术中可发挥一定效果。

Objective:To analyze the effect of modified anterior sciatic nerve block in general anesthesia and orthopaedic surgery.Methods:93 patients undergoing general anesthesia operation in our hospital were selected as the study samples.The operation time was from March 2018 to March 2019.They were divided into group A(31 cases),group B(31 cases)and group C(31 cases)by random number arrangement table.Patients in group A were anesthetized by anterior approach,patients in group B by posterior approach,and patients in group C by modified anterior approach.All patients underwent femoral nerve block after sciatic nerve block.When they reached the anesthesia level required by the operation,they were given combined anesthesia until the operation was completed.The depth of acupuncture,the operation time of sciatic nerve bltx^k,the duration of sciatic nerve block,the depth of sciatic nerve and the dosage of sufentanil were compared among the three groups;The anesthesia effect of the three groups was observed;The shaqjness scores of ultrasound images were compared among the three groups.Results:The depth of acupuncture and the depth of sciatic nerve in group B were less than that in group A and C,the operation time of sciatic nerve block was shorter than that in group A and C,but the duration of sciatic nerve block was longer than that in group A and C,and the dosage of sufentanil was lower than that in group A and C(P<0.05).The total effective rate of anesthesia in group B was lower than that in group A(P<0.05),but there was no significant difference between group C and group B(P>0.05).The clarity of ultrasound image in group C was higher than that in group A and B(P<0.05).Conclusion:The depth of acupuncture,the depth of sciatic nerve,the operation time of sciatic nerve block,the duration of sciatic nerve block and the dosage of sufentanil are all better than those of anterior approach block and modified anterior approach block.The effect of modified anterior sciatic nerve block under the guidance of ultrasound is not as good as that of posterior approach block in general anesthesia and orthopedic surgery,and it is better than that of conventional anterior approach block,the difference is not significant,but the operation is simple and the ultrasonic image is clear,which can play a certain role in the clinical orthopedic surgery.