超声引导下坐骨神经联合股神经阻滞用于足踝部手术的临床观察

Clinical observation of ultrasound-guided sciatic nerve block combined with femoral nerve block for foot and ankle surgery

目的探讨超声引导下坐骨神经阻滞联合股神经阻滞用于足踝部手术的临床效果。方法选择2018年2月—2019年7月在我院行手术治疗的95例足踝部手术的患者,采用随机数表法分为对照组(n=47)和观察组(n=48)。对照组采用腰硬联合麻醉,观察组采用超声引导下的坐骨神经联合股神经阻滞,对比两组麻醉前(T0)、手术开始时(T_(1))、手术开始后30 min(T_(2))、手术结束时(T_(3))患者的血流动力学[心率(HR)、舒张压(DBP)、收缩压(SBP)、血氧饱和度(SpO2)]、镇痛效果(VAS)。结果两组患者T0的HR、DBP水平差异无统计学意义(t=0.707,P=0.481;t=0.676,P=0.501),观察组T_(1)的HR、DBP水平均高于对照组,差异有统计学意义(t=6.480,P<0.001;t=2.758,P=0.007);两组患者T0SBP水平差异无统计学意义(t=0.316,P=0.753),观察组T_(1)、T_(2)、T_(3)的SBP水平均高于对照组,差异有统计学意义(t=3.496,P=0.001;t=2.708,P<0.001;t=5.182,P<0.001);两组患者各个时间段的SpO2水平差异无统计学意义(t=0.774、1.790、1.915、1.908,P>0.05);观察组术后1 h、12 h、24 h VAS评分均低于对照组,差异有统计学意义(t=5.037,6.843,6.442,P<0.05)。结论超声引导下坐骨神经阻滞联合股神经阻滞用于足踝部手术效果满意,术中对血流动力学影响小,术后镇痛时间长。

Objective To investigate the clinical effect of ultrasound-guided sciatic nerve block combined with femoral nerve block in ankle surgery.Methods From February 2018 to July 2019, 95 patients with ankle surgery in our hospital were randomly divided into a control group(n = 47) and an observation group(n = 48).The control group was given the combined spinal epidural anesthesia, and the observation group was treated with ultrasound-guided sciatic nerve combined with femoral nerve block.The hemodynamics [(heart rate(HR), diastolic blood pressure(DBP), systolic blood pressure(SBP), blood oxygen saturation(SpO2) and analgesic effect(VAS)] were compared between the two groups before anesthesia(T0), at the beginning of operation(T_(1)), 30 minutes after operation(T_(2)), and at the end of operation(T_(3)).Results There was no significant difference in the HR and DBP levels of T0 between the two groups(t = 0.707, P = 0.481;t = 0.676, P =0.501), but the HR and DBP levels of T_(1) in the observation group were higher than those in the control group(t = 6.480, P <0.001;t = 2.758, P = 0.007).There was no significant difference in the level of SBP at T0 between the two groups(t = 0.316,P = 0.753).The SBP levels at T_(1), T_(2) and T_(3) in the observation group were higher than those in the control group(t = 3.496,P = 0.001;t = 2.708, P < 0.001;t = 5.182, P < 0.001);There was no significant difference in SpO2 level at each time quantum between the two groups(t = 0.774, 1.790, 1.915, 1.908, all P > 0.05).VAS scores at 1 h, 12 h and 24 h in the observation group were lower than those in the control group(t = 5.037, 6.843, 6.442, all P < 0.05).Conclusion Ultrasound guided sciatic nerve block combined with femoral nerve block for foot and ankle surgery has satisfactory effect, little influence on hemodynamics during operation, and long postoperative analgesia time.