超声联合神经刺激器引导下腰丛-腘窝坐骨神经阻滞在大隐静脉曲张手术中的应用效果

摘要

目的 观察超声联合神经刺激器引导下的腰丛联合腘窝坐骨神经阻滞在单侧大隐静脉曲张手术中的麻醉效果.方法 选择2015年1月至2015年12月在安徽医科大学附属省立医院择期行单侧大隐静脉曲张手术患者60例,ASA分级Ⅰ~Ⅱ级,采用随机数字表法将其分为神经阻滞组(NB组,30例)和硬膜外麻醉组(EA组,30例).记录两组麻醉前(T0)、麻醉后10分钟(T1)、30分钟(T2)、60分钟(T3)的收缩压、舒张压及心率;记录两组感觉阻滞起效时间、感觉阻滞维持时间、术中麻黄碱使用情况、麻醉效果及术后随访情况(恶心呕吐及尿潴留).结果 与EA组相比,NB组T2时的收缩压(SBP)及舒张压(DBP)高于EA组(P<0.05);NB组感觉阻滞起效时间小于EA组(P<0.05),阻滞维持时间大于EA组;NB组术中麻黄碱使用例数小于EA组(P<0.05);两组在麻醉优良率方面差异无统计学意义(P>0.05),尿潴留NB组中的发生率低于EA组,差异有统计学意义(P<0.05),而恶心呕吐方面比较,两组发生率的差异无统计学意义(P>0.05).结论 超声联合神经刺激器引导下腰丛-腘窝坐骨神经阻滞用于单侧大隐静脉曲张手术的麻醉效果与硬膜外麻醉相似,且具有血流动力学影响小、术后并发症少等优点.%Objective To investigate the anesthesia efficacy of lumbar plexus popliteal fossa sciatic nerve block guided by ultrasound and nerve stimulator in the patients undergoing unilateral great saphenous varicose veins surgery. Methods Sixty patients scheduled for uni-lateral great saphenous varicose veins surgery in our hospital from Jan 2015 to Dec 2015, in ASA grade Ⅰ and Ⅱ, were selected and divided into the nerve block group ( group NB, 30 cases) and the epidural anesthesia group ( group EA, 30 cases) by randomized number table method. The systolic blood pressure ( SBP) , diastolic blood pressure ( DBP) and heart rate ( HR) of all patients at the time of before anes-thesia ( T0 ) and 10 min ( T1 ) , 30 min ( T2 ) , 60 min ( T3 ) after anesthesia were recorded. And the onset time and sustained time of sensory block, use of ephedrine after anesthesia, anesthesia efficacy and postoperative adverse reactions ( nausea and vomiting, urinary retention) in the two groups were also recorded. Results Compared with the EA group, the NB group had significant higher SBP and DBP at the time of T2(P<0. 05), and it had shorter onset time of sensory block and longer sustained time of sensory block. The cases of ephedrine usage after anesthesia in the NB group were significantly fewer than those in the EA group (P<0. 05). There was no significantly difference in the excel-lent and good anesthesia efficacy between the two groups, so was the difference in the incidence of nausea and vomiting between them ( P>0. 05). But the incidence of urinary retention in the NB group was significantly lower than that in the EA group (P<0. 05). Conclusion In the patients undergoing unilateral great saphenous varicose veins surgery, the anesthesia efficacy of lumbar plexus popliteal fossa sciatic nerve block guided by ultrasound and nerve stimulator would be similar to that of epidural anesthesia, with further advantages of stable hemo-dynamics and fewer complications.