超声引导下股神经阻滞联合硬膜外麻醉在大隐静脉激光闭合术中的应用

Application of ultrasound-guided femoral nerve block combined with epidural anesthesia in laser closure of the great saphenous vein

目的探讨超声引导下股神经阻滞联合硬膜外麻醉在大隐静脉激光闭合术中的应用效果。方法收集2020年5月至2023年7月于铜陵市人民医院接受大隐静脉激光闭合术治疗的120例大隐静脉曲张患者的临床资料,根据麻醉方式的不同将患者分为联合组(n=57)和对照组(n=63)。联合组患者在手术过程中采用超声引导下股神经阻滞联合硬膜外麻醉,对照组仅采用硬膜外麻醉。比较两组患者的手术指标、麻醉相关指标、术后不同时间(术后1、6、12、24 h)的疼痛感[视觉模拟评分法(VAS)评分]、术后首次下床活动时间及术后并发症的发生情况。结果联合组患者的手术时间短于对照组患者(P﹤0.05);两组患者的术中输液量比较,差异无统计学意义(P﹥0.05)。在首次穿刺大隐静脉时和手术完成即刻两个时间点,联合组患者的心率和平均动脉压均低于对照组患者(P﹤0.05)。联合组患者术后各时间点的VAS评分均明显低于对照组患者,术后首次下床活动时间明显短于对照组患者(P﹤0.01)。两组患者术后并发症发生情况比较,差异无统计学意义(P﹥0.05)。结论对于行大隐静脉激光闭合术的大隐静脉曲张患者,超声引导下股神经阻滞联合硬膜外麻醉可以安全、显著地改善其术后疼痛感,同时改善患者围手术期心率、血压,缩短手术时间,且不会增加术后并发症。

Objective To investigate the application effect of ultrasound-guided femoral nerve block combined with epidural anesthesia in laser closure of the great saphenous vein.Method The clinical data of 120 patients with varicose great saphenous vein who underwent laser closure surgery at Tongling People's Hospital from May 2020 to July 2023 were collected.The patients were divided into combination group(n=57)and control group(n=63)according to different anesthesia methods.The combination group of patients used ultrasound guided femoral nerve block combined with epidural anesthesia during the surgery,while the control group only used epidural anesthesia.The surgical indicators,anesthesia related indicators,pain perception at different postoperative times(postoperative 1,6,12,24 h)using visual analogue scale(VAS)score,the time to first get out of bed after surgery,and incidence of postoperative complications between two groups of patients were compared.Result The surgical time of the combination group patients was shorter than that of the control group patients(P<0.05);there was no statistically significant difference in intraoperative infusion volume between the two groups of patients(P>0.05).At the two time points of the first puncture of the great saphenous vein and immediately after the completion of the surgery,the heart rate and mean arterial pressure of the combination group patients were lower than those of the control group patients(P<0.05).The VAS scores of patients in the combination group were significantly lower than those in the control group at all time points after surgery,and the time to first get out of bed after surgery was significantly shorter than that of the control group(P<0.01).There was no statistically significant difference in the incidence of postoperative complications between the two groups of patients(P>0.05).Conclusion For patients with varicose great saphenous vein undergoing laser closure surgery,ultrasound-guided femoral nerve block combined with epidural anesthesia can safely and significantly improve their postoperative pain,as well as improve their perioperative heart rate and blood pressure,shorten the surgical time,and not increasing postoperative complications.