右美托咪定复合彩超引导神经阻滞用于糖尿病足清创VSD手术的麻醉效果

Anesthetic effect of dexmedetomidine combined with color ultrasound-guided nerve block for diabetic foot debridement VSD surgery

目的与蛛网膜下腔麻醉相比,探讨右美托咪定复合彩超引导神经阻滞用于糖尿病足清创真空封闭引流(VSD)手术的麻醉效果。方法选择2019年6月至2020年12月厦门市第三医院住院的择期糖尿病足清创VSD手术患者60例,ASAⅡ~Ⅲ级,随机分为蛛网膜下腔麻醉组(S组)与神经阻滞麻醉组(N组)。S组患者先行蛛网膜下腔麻醉(0.5%盐酸罗哌卡因3.0 mL),再推注泵输注右美托咪定维持镇静。N组患者在腹股沟韧带下彩超引导行髂筋膜阻滞(0.4%盐酸罗哌卡因30 mL)和腘窝上坐骨神经阻滞(0.4%盐酸罗哌卡因20 mL),再推注泵输注右美托咪定维持镇静。记录两组患者麻醉操作时间,测定麻醉起效时间及镇痛持续时间,记录麻醉过程中使用升压药的例数,统计两组麻醉过程中右美托咪定用量,记录术后24 h使用舒芬太尼的用量,由患者评估术后镇痛满意度(满意、一般、不满意),统计有关并发症(恶心、呕吐、尿潴留)的发生率。结果两组患者年龄等一般情况及右美托咪定用量比较,差异无统计学意义(P>0.05),N组使用升压药例数少于S组,差异有统计学意义(P<0.05)。N组麻醉操作时间和起效时间长于S组,差异有统计学意义(P<0.05),N组镇痛持续时间长于S组,差异有统计学意义(P<0.05),N组术后镇痛满意率高于S组,差异有统计学意义(P<0.05),N组尿潴留发生率少于S组,差异有统计学意义(P<0.05)。结论与蛛网膜下腔麻醉相比,彩超引导神经阻滞的操作时间、起效时间较长,但能减少麻醉过程中使用升压药,有效地延长镇痛持续时间及提高术后镇痛满意度,减少使用术后镇痛药物,促进患者的快速康复。

Objective To investigate the anesthetic effect of dexmedetomidine combined with color ultrasound-guided nerve block for diabetic foot debridement vacuum sealing drainage(VSD)surgery compared with subarachnoid anesthesia.Methods A total of 60 patients with elective diabetic foot debridement VSD surgery,ASA grade II-III,hospitalized in the Third Hospital of Xiamen from June 2019 to December 2020 were selected and randomly divided into subarachnoid anesthesia group(group S)and nerve block anesthesia group(group N).In group S,patients were given subarachnoid anesthesia(drug dose:0.5%ropivacaine hydrochloride 3.0 ml)followed by dexmedetomidine infusion by an injection pump to maintain sedation.In group N,patients underwent iliac fascia block(drug dose:0.4%ropivacaine hydrochloride 30 ml)and superior popliteal sciatic nerve block(drug dose:0.4%ropivacaine hydrochloride 20 ml)guided by ultrasound under the inguinal ligament,and then dexmedetomidine was infused to maintain sedation.The operation time of anesthesia was recorded in both groups,and the onset of anesthesia and duration of analgesia were measured.The case number of using hypertension drugs during anesthesia was recorded,and the amount of dexmedetomidine used during anesthesia in both groups was counted.The amount of sufentanil used 24 hours after surgery was recorded.The satisfaction of postoperative analgesia(satisfactory,fair,and unsatisfactory)was assessed by patients,and the incidence of related complications(nausea,vomiting,urinary retention)was counted.Results There was no statistically significant difference between the two groups in terms of general conditions such as age and dexmedetomidine dosage.The case number of using hypertension drugs in group N was less than that in group S(P<0.05).The operation time and onset time of anesthesia in group N were longer than that in group S(P<0.05),and the duration of analgesia in group N was longer than that in group S(P<0.05).The satisfaction rate of postoperative analgesia in group N was higher than that in group S(P<0.05).The incidence of urinary retention in group N was less than that in group S(P<0.05).Conclusion The operation time and onset time of color ultrasound-guided nerve block are longer than that of subarachnoid anesthesia;however,it can reduce the use of hypertension drugs during anesthesia,effectively prolong the duration of analgesia and improve postoperative analgesic satisfaction,reduce the use of postoperative analgesic drugs,and promote rapid recovery of patients.