摘要
目的 :探讨超声引导腘窝上坐骨神经联合隐神经阻滞在前足矫形手术中的临床疗效。方法 :自2017年1月至2017年10月,将60例拇外翻合并跖趾关节脱位需要手术治疗的患者,采用随机数字表法分为试验组和对照组。试验组30例采用超声引导腘窝上坐骨神经联合隐神经阻滞,其中男13例,女17例,年龄31～76(59.23±10.07)岁;体重指数为21～30(24.57±1.85) kg/m^2;ASA分级:Ⅰ级12例,Ⅱ级18例。对照组30例采用单次腰麻,其中男12例,女18例,年龄20～74(54.20±15.87)岁;体重指数为20～29(24.43±3.15) kg/m^2;ASA分级:Ⅰ级11例,Ⅱ级19例。观察两组患者麻醉的阻滞时间、感觉神经阻滞起效时间、运动神经阻滞起效时间、运动神经经阻滞失效时间、感觉神经阻滞失效时间;比较阻滞前(T_0),阻滞后15 min(T_1),阻滞后30 min(T_2),手术开始时(T_3),手术开始后30 min(T_4),术毕(T_5)的血流动力学变化,观察患者的不良反应情况及主观满意度。结果:两种麻醉方案均获得满意的临床效果。试验组的麻醉阻滞时间、感觉神经阻滞起效时间、运动神经阻滞失效时间、感觉神经阻滞失效时间长于对照组,差异有统计学意义(P<0.001);两组的运动神经阻滞起效时间相比,差异无统计学意义(P>0.05)。试验组麻醉后各时间点的收缩压(SBP)、舒张压(DBP)和心率(HR)与阻滞前(T_0)相比,差异无统计学意义(P>0.05);对照组麻醉后各时间点的收缩压(SBP)、舒张压(DBP)与阻滞前(T_0)相比,差异有统计学意义(P<0.05);心率(HR)与阻滞前(T_0)相比,差异无统计学意义(P>0.05)。结论:超声引导腘窝上坐骨神经联合隐神经阻滞能够满足拇外翻及前足疾病手术的需求,维持血流动力学平稳,同时可有效延长术后镇痛时间,并且膝关节以上部位可以自由活动,提高了患者的整体舒适度及安全性。
Objective：To explore clinical effects of ultrasound guided popliteal sciatic nerve combined saphenous nerve block in patients with anterior foot orthopedics. Methods：From January 2017 to October 2017,60 hallux valgus patients with metatarsophalangeal joint dislocation were randomly divided into experimental and control group according to random number table. Thirty patients in experimental group were treated by ultrasound guided popliteal sciatic nerve combined saphenous nerve block,including 13 males and 17 females,aged 31 to 76 years old with an average of（59.23±10.07） years old;and body mass index ranged from 21 to 30 kg/m^2 with an average of（24.57±1.85） kg/m^2;12 cases were gradeⅠand 18 cases were gradeⅡaccording to ASA grading. Thirty patients in control group were treated by spinal anesthesia,including 12 males and 18 females,aged from 20 to 74 years old with an average of（54.20±15.87） years old;and body mass index ranged from 20 to 29 kg/m2 with an average of（24.43 ± 3.15） kg/m^2;11 cases were gradeⅠand 19 cases were gradeⅡaccording to ASA grading. Block time of anesthesia,onset time of sensory nerve block,onset time of motor nerve block,invalid time of motor nerve block,invalid time of sensory nerve block were compared between two groups. Hemodynamic changes before anesthesia（T_0）,15 min after block（T_1）,30 min after block（T_2）,at the beginning of the operation（T_3）,30 min after the beginning（T_4） of surgery and at the end of operation（T_5）,adverse reactions and subjective satisfactory between two groups were also recorded. Results：Both of the anesthetic protocol could achieved satisfied clinical effects. In experimental group,block time of patients,onset time of sensory block,invalid time of motor nerve block and invalid time of sensory nerve block were longer than those in control group,and there were significant differences between two groups（P〈0.001）. There was no significant difference between two groups in onset time of motor nerve block（P〈0.05）. There were no significant differences of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）in experimental group at different time points（P〈0.05）. There were significant differences of SBP,DBP in control group at different time points（P〈0.05）. There was no significant difference of HR in control group at different time points（P〈0.05）. Conclusion：Ultrasound guided popliteal sciatic nerve combined saphenous nerve block could meet demand of hallux valgus patients with metatarsophalangeal joint dislocation. Compared with lumbar anesthesia,it could maintain hemodynamic stability,prolong effective analgesia time after operation,and improve patients＇ overall comfort and safety for free activity above the knee joint.
作者
徐惠青
张志军
贾若
段立鹏
XU Hui-qing;ZHANG Zhi-jun;JIA Ruo;and DUAN Li-peng(Department of A nesthesialogy,Wangjing Hospital of China Aeademy of Chinese Medical Sciences,Beijing 100102,China)
出处
《中国骨伤》
CAS
2018年第10期907-911,共5页
China Journal of Orthopaedics and Traumatology
基金
2016年中国中医科学院望京医院院内课题(编号:WJYY2016-PY-027)~~
关键词
坐骨神经
拇外翻
跖趾关节
关节脱位
Sciatic nerve
Hallux valgus
Metatarsophalangeal joint
Joint dislocations
