超声引导下坐骨神经加隐神经阻滞联合全身麻醉在小儿足踝部手术中的应用

Application of ultrasound-guided sciatic-saphenous nerve blocks in foot and ankle surgery of children

目的探讨超声引导下坐骨神经联合隐神经阻滞在小儿足踝部手术中的应用。方法选择择期行足踝部手术的患儿40例,随机分成2组:对照组(C组)和神经阻滞组(N组),每组20例,均采用七氟烷诱导并维持、喉罩-自主呼吸的麻醉方法。N组诱导后行超声引导下坐骨神经阻滞和隐神经阻滞,C组不作处理。术中调节七氟烷浓度维持麻醉。观察并记录麻醉诱导前即刻(T_0)、切皮时(T_1)、手术开始后30 min(T_2)、术毕即刻(T_3)、拔除喉罩即刻(T_4)、拔除喉罩后10 min(T_5)的平均动脉压(MAP)和心率(HR),记录挥发罐刻度线以计算七氟烷用量,苏醒时间,躁动情况及术后2 h、4 h、8 h、16 h的CHEOPS评分。结果与C组比较,N组于T_1~T_5时MAP、HR明显降低,七氟烷用量明显减少,苏醒时间明显缩短,术后烦躁例数明显减少,术后各时点CHEOPS评分显著降低(P<0.05)。结论在小儿足踝部手术中,超声引导下坐骨神经联合隐神经阻滞可以使血流动力学更加平稳,七氟烷用量减少,患儿苏醒时间缩短,术后烦躁的发生减少,并能提供有效的术后镇痛。

Objective To investigate application of ultrasound-guided sciatic-saphenous nerve blocks in foot and ankle surgery of children.Methods Forty children undergoing foot and ankle surgery were randomly allocated into two groups:the control group(group C),nerve block group(group N),all children were accepted sevoflurane and spontaneous breath with LMA to anesthesia.Sciatic-saphenous nerve block was given after anesthesia induction in group N.Adjusting the concentration of sevoflurane according to the depth of anesthesia.Recorded the HR and MAP before induction of anesthesia(T_0),at the time of incision(T_1),30 mins after the beginning of the operation(T_2),end of operation(T_3),extubation(T_4),10 mins after extubation(T_5).Recorded the volatile tank calibrations to calculate the dosage of sevoflurane,recovery times,the case of irritability and the cheops scores at 2,4,8,16 h postoperatively were also recorded.Results Compared with group C,the HR and MAP of group N at T_(1-5) were significantly lower(P<0.05);The recovery times were significantly shorter and the cases of irritability were significantly lower(P<0.05);The cheops scores of the postoperative time-points decreased significantly(P<0.05).Conclusion Application of ultrasound-guided sciatic-saphenous nerve blocks can keep hemodynamic more stable,reduce the amount of sevoflurane,shorten recovery time,reduce the occurrence of postoperative irritability and provide better postoperative analgesia.