髂筋膜间隙联合腘窝上角坐骨神经阻滞用于糖尿病足膝下截肢术抗凝患者的镇痛及康复效果

Analgesic and rehabilitation effects of fascia iliaca compartment block combination with popliteal sciatic nerve block in anticoagulant patients undergoing diabetic foot below-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)联合腘窝上角坐骨神经阻滞(UPSNB)用于糖尿病足抗凝治疗患者膝下截肢术围手术期镇痛和康复的效果。方法选择糖尿病足膝下截肢术抗凝治疗患者40例,按麻醉方法的不同分为A、B两组,每组20例。A组行全麻;B组行超声引导LSFICB+UPSNB。观察并记录麻醉前(T_(pre))、麻醉后12 h(T_(12))、麻醉后24 h(T_(24))、麻醉后48 h(T_(48))时疼痛数字评价量表(NRS)。记录患者术后开始饮食时间、首次疼痛时间、住院时间、医疗花费;记录术中血管活性药物使用例数,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A组T_(12)、T_(24)、T_(48)时NRS评分明显高于B组(分:4.05±1.15比2.30±0.80,3.75±1.21比2.45±1.00,2.05±0.69比1.60±0.68,均P<0.05)。A组术后开始饮食时间(h:7.20±2.82比3.60±1.47)、住院时间(d:7.85±1.98比6.05±1.70)、医疗花费(万元:1.50±0.34比0.98±0.18)明显高于B组(均P<0.05),首次疼痛时间明显少于B组(h:3.50±1.32比23.55±5.41,P<0.05)。A组术中血管活性药物使用率及头晕、尿潴留、恶心/呕吐、睡眠障碍、切口重度疼痛等不良反应发生率均明显高于B组〔80%(16/20)比20%(4/20),60%(12/20)比20%(4/20),80%(16/20)比10%(2/20),85%(17/20)比20%(4/20),75%(15/20)比25%(5/20),60%(12/20)比10%(2/20),均P<0.05〕。结论糖尿病足膝下截肢术抗凝患者行超声引导LSFICB联合UPSNB安全可靠,较静脉吸入全麻更具镇痛、加速康复的优势。

Objective To observe the analgesic and rehabilitation effects of longitudinal supra-inguinal fascia iliaca compartment block(LSFICB)combination with upper popliteal angle sciatic nerve block(UPSNB)on anticoagulant patients undergoing diabetic foot below-knee amputation.Methods Forty patients with anticoagulant therapy scheduled for diabetic foot under-knee amputation were selected and divided into A and B groups according to the different methods of anesthesia,with 20 cases in each group.Group A received general anesthesia,group B received LSFICB and UPSNB.Numerical rating scale(NRS)was observed and recorded before anesthesia(T_(pre))and post anesthesia 12 h(T_(12)),24 h(T_(24)),48 h(T_(48)).The time of starting eating,first pain,hospitalization,and medical costs were recorded.The incidence of need for vasoactive agents during operation,dizziness,urinary retention,nausea and vomiting,dyssomnia,and severe incision pain within 48 hours post operation were also recorded.Results The NRS scores post anesthesia at T_(12),T_(24) and T_(48) in group A were significantly higher than those in group B(scores:4.05±1.15 vs.2.30±0.80,3.75±1.21 vs.2.45±1.00,2.05±0.69 vs.1.60±0.68,all P<0.05).The time of start eating(hours:7.20±2.82 vs.3.60±1.47),hospitalization(days:7.85±1.98 vs.6.05±1.70)and medical costs(ten thousand yuan:1.50±0.34 vs.0.98±0.18)in group A were significantly higher than those in group B(all P<0.05).The incidence of need for vasoactive agents during operation,dizziness,urinary retention,nausea and vomiting,dyssomnia,and severe incision pain within 48 hours post operation in group A were significantly higher than those in group B[80%(16/20)vs.20%(4/20),60%(12/20)vs.20%(4/20),80%(16/20)vs.10%(2/20),85%(17/20)vs.20%(4/20),75%(15/20)vs.25%(5/20),60%(12/20)vs.10%(2/20),all P<0.05].Conclusion The ultrasound-guided LSFICB combination with UPSNB safely and reliably provided superior post-operative pain management and enhanced recovery compared to general anesthesia on anticoagulant patients undergoing diabetic foot below-knee amputation.