超声引导下局部肿胀麻醉联合硬膜外麻醉在大隐静脉激光闭合术中的应用价值

Application value of ultrasound-guided local tumescent anesthesia combined with epidural anesthesia in laser closure of the great saphenous vein

目的探讨超声引导下局部肿胀麻醉联合硬膜外麻醉在大隐静脉激光闭合术中的应用效果。方法依据随机数字表法将2020年2月至2022年4月联勤保障部队第九〇一医院收治的拟行大隐静脉激光闭合术的92例下肢静脉曲张患者分为观察组和对照组,每组46例。所有患者均由同一组医师进行大隐静脉激光闭合术,对照组患者单纯应用硬膜外麻醉,观察组患者在硬膜外麻醉的基础上采取超声引导下局部肿胀麻醉。比较两组患者不同时间点[手术前(T_(0))、手术开始即刻(T_(1))、手术15 min(T_(2))、术后30 min(T_(3))]的血流动力学指标[平均动脉压(MAP)、心率(HR)]。采用视觉模拟评分法(VAS)评估并比较两组患者术后不同时间(术后麻醉恢复即刻、术后2 h、术后4 h、术后8 h)的镇痛效果。比较两组患者围手术期相关指标(手术时间、术后首次下床活动和术后皮肤瘀斑面积)。结果两组患者T_(0)、T_(1)的MAP比较,差异均无统计学意义(P﹥0.05);观察组患者T_(2)、T_(3)的MAP均明显高于对照组患者,差异均有统计学意义(P﹤0.01)。观察组患者不同时间点的MAP比较,差异无统计学意义(P=0.214);对照组患者不同时间点的MAP比较,差异有统计学意义(P﹤0.01)。两组患者T_(0)、T_(3)的HR比较,差异无统计学意义(P﹥0.05);观察组患者T_(1)、T_(2)的HR均明显高于对照组患者,差异均有统计学意义(P﹤0.01)。观察组患者术后2、4、8 h的VAS评分均明显低于对照组患者,差异均有统计学意义(P﹤0.01)。两组患者组内不同时间点的HR、VAS评分比较,差异均有统计学意义(P﹤0.01)。两组患者的手术时间比较,差异无统计学意义(P﹥0.05)。观察组患者的术后首次下床时间明显短于对照组患者,术后皮肤瘀斑面积明显小于对照组患者,差异均有统计学意义(P﹤0.01)。结论与单纯应用硬膜外麻醉相比,超声引导下局部肿胀麻醉联合硬膜外麻醉在大隐静脉激光闭合术中的应用效果良好,可显著降低患者术后疼痛感,缩短患者术后首次下床时间,缩小术后皮肤瘀斑面积,对患者术中血流动力学的影响较小。

Objective To investigate the application effect of ultrasound-guided local tumescent anesthesia combined with epidural anesthesia in laser closure of the great saphenous vein.Method A total of 92 patients who were admitted to 901st Hospital,Joint Logistic Support Force,Chinese People's Liberation Army from February 2020 to April 2022 and planned to undergo laser closure of the great saphenous vein,they were divided into observation group and control group by random number table method,with 46 cases in each group.All patients underwent laser closure of the the great saphenous vein by the same group of physicians.The patients in the control group received epidural anesthesia,and the observation group received ultrasound-guided local tumescent anesthesia on the basis of epidural anesthesia.The hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR)]of the two groups were compared at different time points[before surgery(T_(0)),immediately after surgery(T_(1)),15 minutes after surgery(T_(2)),and 30 minutes after surgery(T_(3))].The visual analogue scale(VAS)was used to evaluate and compare the analgesic effects of two groups of patients at different postoperative times(immediate postoperative anesthesia recovery,2 h after surgery,4 h after surgery,and 8 h after surgery).The perioperative related indicators(operation time,first ambulation time after operation,postoperative skin ecchymosis area)of patients between two groups were compared.Result There was no statistically significant difference in the MAP of T_(0)and T_(1)between the two groups of patients(P>0.05);the MAP of T_(2)and T_(3)in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.01).There was no statistical difference in MAP at different time points in the observation group(P=0.214),but there was a statistically significant difference in MAP at different time points in the control group(P<0.01).There was no statistically significant difference in HR between the two groups of patients with T_(0)and T_(3)(P>0.05);the HR of T_(1)and T_(2)in the observation group was significantly higher than that in the control group,and the differences were statistically significant(P<0.01).The VAS scores of the observation group at 2 h,4 h,and 8 h after surgery were significantly lower than those of the control group,and the differences were statistically significant(P<0.01).The comparison of HR and VAS scores at different time points within the two groups of patients showed statistically significant differences(P<0.01).There was no significant difference in operation time between the two groups(P>0.05).The time of first getting out of bed in the observation group was significantly shorter than that in the control group,and the postoperative skin ecchymosis area was significantly smaller than that in the control group,and the differences were statistically significant(P<0.01).Conclusion Compared with epidural anesthesia alone,ultrasound-guided local tumescent anesthesia combined with epidural anesthesia has good application effect in laser closure of saphenous vein,which can significantly reduce postoperative pain and shorten the time of first getting out of bed of patients,reduce the area of skin ecchymosis after surgery,and has little effect on the intraoperative hemodynamics of patient.