B超引导踝部神经阻滞在老年糖尿病足患者截趾手术中的应用

Application of ultrasound-guided ankle nerve block in toe amputation for elderly patients with diabetic foot

目的了解踝部神经阻滞在老年糖尿病足患者截趾手术中的麻醉效果。方法选择须行截趾手术治疗的糖尿病足患者40例,采用随机数字表法将患者随机分为两组,每组20例。一组(N组)行B超引导下踝部神经阻滞,另一组(S组)行蛛网膜下腔阻滞,并在麻醉开始前(T0)、手术开始前10 min(T1)、切皮即刻(T2)、手术开始后1 h(T3)、手术结束时(T4)、术后5 h(T5)记录患者的疼痛视觉模拟评分(VAS)以及患者阻滞成功操作时间、术中辅助使用多巴胺的情况、T5时两组患者的腰背痛情况。结果两组患者围术期各时点的VAS评分差异无统计学意义(P>0.05)。与同组T0时比较,T1、T2、T3、T4时患者的VAS评分明显降低(P<0.01)。N组患者麻醉成功操作时间明显短于S组(P<0.01),术中使用多巴胺及术后腰背痛发生情况明显少于S组(P<0.01)。结论B超引导踝部神经阻滞在老年糖尿病患者截趾手术中镇痛效果好,对患者全身影响少,值得临床推广。

Objective To investigate the anesthetic effect of ultrasound-guided ankle nerve block in toe amputation for elderly patients with diabetic foot.Methods Forty patients with diabetic foot requiring toe amputation were randomly divided into two groups,20 cases in each group.Group N underwent ultrasound-guided ankle nerve block while Group S underwent spinal subarachnoid block.VAS scores of the patients,time for successful block and intraoperative administration of dopamine were recorded before anesthesia(T0),10 min before operation(T1),immediately after skin cutting(T2),1 hour after operation(T3),at the end of operation(T4),and 5 h after operation(T5).The number of patients with low back pain in the two groups at T5 was recorded.Results There was no significant difference in VAS score at each time point during perioperative period between the two groups(P>0.05).Compared with that at T0 of the same group,the VAS scores at T1,T2,T3 and T4 were significantly reduced(P<0.01).Group N had a significantly shorter time for successful block than Group S(P<0.01),and less intraoperative administration of dopamine and postoperative low back pain than Group S(P<0.01).Conclusion The application of B-ultrasound-guided ankle nerve block in toe amputation for elderly patients with diabetic foot has a good efficacy and causes little systematic impact on the patients.It is worthy of clinical promotion.