硬膜外麻醉与蛛网膜下腔麻醉在深静脉瓣膜功能不全手术中的疗效

Curative effect between epidural anesthesia and subarachnoid anesthesia in deep vein valve insufficiency surgery

目的 探讨硬膜外麻醉与蛛网膜下腔麻醉在深静脉瓣膜功能不全手术中的疗效。方法 收集2018年4月至2020年4月北京积水潭医院收治的114例深静脉瓣膜功能不全患者的临床资料。根据不同的麻醉方式将患者分为对照组(采用硬膜外麻醉)和观察组(采用蛛网膜下腔麻醉),每组57例。比较两组患者手术过程中的收缩压、舒张压、心率的波动情况。比较两组患者麻醉药物用量、麻醉起效时间和术后12 h视觉模拟量表(VAS)评分。比较两组患者不同时间的血管超声指标(平均静脉管径、平均血流速度、反流持续时间)。结果 观察组患者在手术过程中的收缩压、舒张压、心率的波动幅度均低于对照组患者,差异均有统计学意义(P<0.05)。麻醉药物用量和术后12 h VAS评分均低于对照组患者,麻醉起效时间短于对照组患者,差异均有统计学意义(P<0.05)。术后2周,观察组患者的平均静脉管径低于对照组患者,反流持续时间短于对照组患者,平均血流速度高于对照组患者,差异均有统计学意义(P<0.05)。结论 深静脉瓣膜功能不全患者采用蛛网膜下腔麻醉方式对循环系统的干扰程度更低,术后的疼痛感更低,短期内恢复更快。

Objective To explore the curative effect between epidural anesthesia and subarachnoid anesthesia in the operation of deep vein valve insufficiency. Method The data of 114 patients with deep vein valve insufficiency who underwent surgery in Beijing Jishuitan Hospital from April 2018 to April 2020 were selected. According to different anesthesia methods, the patients were divided into control group and observation group. The control group was treated with epidural anesthesia, the observation group was treated with subarachnoid anesthesia, 57 cases in each group. The fluctuations of systolic blood pressure, diastolic blood pressure and heart rate of two groups were compared. The dosage of anesthetic drugs, the onset time of anesthesia and the visual analogue scale(VAS) scores of 12 hours after operation of two groups were compared. The vascular ultrasound indexes(mean venous diameter, mean blood flow velocity and reflux duration) of the two groups at different times were compared. Result The fluctuation of systolic blood pressure, diastolic blood pressure and heart rate in the observation group were lower than those in the control group, the differences were statistically significant(P<0.05). The dosage of narcotic drugs and the VAS scores of 12 hours after operation were lower than those in the control group, and the onset time of anesthesia was shorter than that in the control group, the differences were statistically significant(P<0.05). Two weeks after operation, the average venous diameter in the observation group was lower than that in the control group, the duration of reflux was shorter than that in the control group, and the average blood flow velocity was higher than that in the control group, the differences were statistically significant(P<0.05). Conclusion Compared with epidural anesthesia, the application of subarachnoid anesthesia to the operation of patients with deep vein valve insufficiency has less interference with the circulatory system, lower postoperative pain, and short-term pain faster recovery.