添加碳酸氢钠配制的肿胀麻醉液在大隐静脉曲张射频消融术中的应用

Application of Tumescent Solution Prepared with Sodium Bicarbonate in Radiofrequency Ablation of Varicose

目的 探究添加碳酸氢钠的肿胀麻醉液在大隐静脉射频消融术中的安全性及其镇痛效果。方法本研究以2018年1月1日-2022年12月31日某院血管外科收治的主要诊断为大隐静脉曲张,国际疾病分类编码I83.9的患者61例作为研究对象,按照随机数字表法将患者分为2组,I组为利多卡因+肾上腺素组29例;II组为利多卡因+肾上腺素+碳酸氢钠组32例。比较两组患者的术中生命体征、术中及术后的视觉模拟疼痛评分,通过临床表现严重程度评分对各组手术的远期疗效进行评估。结果 两组患者男女比例、平均年龄、BMI、手术时长比较,差异无统计学意义,P>0.05。术中监测I组患者平均收缩压为(123.7±9.5)毫米汞柱、平均舒张压为(81.2±11.6)毫米汞柱g,平均心率为(96.1±6.1)次/分,均高于II组的(113.1±10.9)毫米汞柱、(74.8±6.1)毫米汞柱和(92.7±5.6)次/分,两组比较差异具有统计学意义,P<0.05。出血量比较,差异无统计学意义,P>0.05。术中注射肿胀液时II组的VAS评分为(3.45±0.42)分,低于I组的(4.42±0.53)分;射频治疗时II组VAS为(1.71±0.32)分,低于I组的(1.93±0.48)分,两组比较差异具有统计学意义,P<0.05。术后4小时及8小时,I组的VAS评分显著高于II组,差异具有统计学意义,P<0.05;术后12小时两组VAS评分比较,差异无统计学意义。I组术前VCSS评分为(16.24±2.82)分、术后3个月为(4.45±0.46)分,与II组术前的(16.51±2.33)分和术后3个月的(4.65±0.55)分比较,差异无统计学意义,P>0.05。结论 射频治疗大隐静脉曲张时,使用添加碳酸氢钠,将酸性肿胀液缓冲到生理pH值,可以在术中及术后明显减少患者的疼痛感,显著提升患者围手术期的舒适度,且不影响手术效果,可以作为一种安全可靠的肿胀麻药的配制方法。

Objectives This study aims to investigate the safety and analgesic effect of tumescent combined with sodium bicarbonate in radiofrequency ablation of varicose.Methods In this study,61 patients who were admitted to the Department of Vascular Surgery in a certain hospital from January 1,2018 to December 31,2022 with the main diagnosis of saphenous varicose veins with the International Classification of Diseases code I83.9 were selected as the research objects.Group I consisted of lidocaine+adrenalin with 29 cases;group II consisted of lidocaine+adrenalin+sodium bicarbonate with 32 cases.The intraoperative vital signs,intraoperative and postoperative visual analogue pain scores(VAS)were compared between the groups.The long-term efficacy of each group was evaluated by clinical presentation severity scores(VCSS).Results There were no significant differences in sex,average age,BMI,and operation time between the two groups(P>0.05).During the intraoperative monitoring,the mean systolic blood pressure of patients in group I was 123.7±9.5 mmHg,the mean diastolic blood pressure was 81.2±11.6 mmHg,and the average heart rate was 96.1±6.1 beats/min,which were all higher than 113.1±10.9 mmHg,74.8±6.1 mmHg and 92.7±5.6 beats/min of group II.The difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference in the amount of blood loss(P>0.05).The VAS score of group II was 3.45±0.42 points when the tumescent solution was injected during the operation,which was lower than that of group I,4.42±0.53 points.During radiofrequency treatment,the VAS score of group II was 1.71±0.32,lower than that of group I 1.93±0.48,and the difference between the two groups was statistically significant(P<0.05).At 4 hours and 8 hours after operation,the VAS score of group I was significantly higher than that of group II,and the difference was statistically significant(P<0.05).There was no statistically significant difference in VAS scores between the two groups 12 hours after operation.Conclusions During radiofrequency treatment of saphenous varicose veins,adding sodium bicarbonate to buffer the acidic tumescent solution to physiological pH can significantly reduce the pain of patients during and after the operation and significantly improve the comfort of patients during the perioperative period without affecting the surgical effect.Therefore,this can be used as a safe and reliable preparation method for swelling anesthetics.