超声引导纵向腹股沟韧带上髂筋膜间隙阻滞在糖尿病足膝上截肢术抗凝患者围手术期的镇痛效果

Perioperative analgesic effect of ultrasound-guided longitudinal supra-inguinal fascia iliaca compartment block in anticoagulant patients undergoing diabetic foot upper knee amputation

目的观察超声引导纵向腹股沟韧带上髂筋膜间隙阻滞(LSFICB)用于抗凝治疗糖尿病足膝上截肢术患者的血流动力学变化和镇痛效果。方法选择2016年1月至2021年1月廊坊市人民医院麻醉科收治的喉罩全身麻醉行糖尿病足膝上截肢术抗凝治疗患者40例,按数字表法随机分为A组和B组,每组20例。A组术前静脉注射(静注)舒芬太尼0.1μg/kg,B组术前静注舒芬太尼0.1μg/kg后行超声引导纵向腹股沟韧带上LSFICB,阻滞用药为0.375%罗哌卡因40 mL(150 mg)。观察并记录患者镇痛前、切皮、锯断股骨、清醒时平均动脉压(MAP)和心率(HR),镇痛前、镇痛20 min、镇痛24 h、镇痛48 h时视觉模拟评分(VAS)。记录患者术后48 h内头晕、尿潴留、恶心/呕吐、睡眠障碍、切口重度疼痛等不良反应的例数。结果与A组比较,B组切皮、锯断股骨、清醒时MAP和HR显著降低,差异有统计学意义〔MAP(1 mmHg≈0.133 kPa):切皮为91.85±7.05比116.40±7.45,锯断股骨为106.60±6.86比122.90±6.84,清醒为100.00±8.93比114.15±9.57;HR(次/min):切皮为70.80±10.36比87.50±8.16,锯断股骨为75.80±8.81比94.45±9.34,清醒为77.45±10.41比87.60±11.46,均P<0.05〕。B组镇痛20 min、镇痛24 h、镇痛48 h时VAS评分亦显著降低,差异有统计学意义〔(分):镇痛20 min为2.50±0.83比4.05±0.89,镇痛24 h为2.70±0.73比4.35±0.67,镇痛48 h为1.10±0.92比3.10±1.07,均P<0.05〕。两组术后48 h内不良事件发生率比较差异有统计学意义〔头晕:65%(13/20)比25%(5/20),尿潴留:60%(12/20)比15%(3/20),恶心/呕吐:80%(16/20)比20%(4/20),睡眠障碍:70%(14/20)比25%(5/20),切口重度疼痛:40%(8/20)比10%(2/20),均P<0.05〕。结论糖尿病足膝上截肢术抗凝患者术前行超声引导纵向LSFICB安全有效,术中血流动力学稳定,围手术期期镇痛完善。

Objective To observe the hemodynamic changes and perioperative analgesic effect of ultrasoundguided longitudinal suprainguinal fascia iliaca compartment block(LSFICB)on anticoagulant patients undergoing diabetic foot upper knee amputation.Methods Forty patients scheduled for diabetic foot upper knee amputation undergoing laryngeal mask airway general anesthesia admitted in the department of anaesthesiology of Langfang People's Hospital from January 2016 to January 2021.The patients were divided into group A and group B(n=20 in each group)by the random number table method.Before surgery,group A(sufentanil group)received sufentanil 0.1μg/kg intravenous injection(iv),group B(sufentanil+LSFICB group)received sufentanil 0.1μg/kg intravenous injection(iv)and LSFICB,40 mL of 0.375%(150 mg)ropivacaine were injected guiding by ultrasound in group B.The change of mean arterial pressure(MAP)and heart rate(HR)were observed and recorded at pre-analgesia,skin incision,cut femur and sober;visual analogue scale(VAS)were observed and recorded at pre-analgesia,post-analgesia 20 minutes,24 and 48 hours.The incidence of dizziness,urinary retention,vomiting/nausea,dyssomnia,severe incision pain and other adverse reactions were recorded within 48 hours after surgery.Results Compared with group A,MAP and HR in group B were significantly decreased at skin incision,cut femur and sober,the difference was statistically significant[MAP(1 mmHg≈0.133 kPa):91.85±7.05 vs.116.40±7.45 at skin incision,106.60±6.86 vs.122.90±6.84 at cut femur,100.00±8.93 vs.114.15±9.57 at sober;HR(times/min):70.80±10.36 vs.87.50±8.16 at skin incision,75.80±8.81 vs.94.45±9.34 at cut femur,77.45±10.41 vs.87.60±11.46 at sober,all P<0.05].The VAS scores post-analgesia 20 minutes,24 and 48 hours in group B also significantly reduced,the difference was statistically significant[(scores)2.50±0.83 vs.4.05±0.89 post-analgesia 20 minutes,2.70±0.73 vs.4.35±0.67 post-analgesia 24 hours,1.10±0.92 vs.3.10±1.07 post-analgesia 48 hours,all P<0.05].The incidence of adverse reactions within 48 hours after surgery had significant difference between group A and B[dizziness:65%(13/20)vs.25%(5/20),urinary retention:60%(12/20)vs.15%(3/20),vomiting/nausea:80%(16/20)vs.20%(4/20),dyssomnia:70%(14/20)vs.25%(5/20),severe incision pain:40%(8/20)vs.10%(2/20),all P<0.05].Conclusions The ultrasound-guided longitudinal supra-inguinal fascia iliaca compartment block can safely and effectively maintain intraoperative hemodynamic stability and relieve perioperative pain on anticoagulant patients undergoing diabetic foot upper knee amputation.