股神经和股外侧皮神经阻滞联合全麻对下肢手术止血带反应及缺血再灌注的影响

摘要

目的：：观察股神经和股外侧皮神经阻滞联合全麻对下肢手术止血带反应及缺血再灌注的影响。方法：选择择期单侧胫腓骨手术患者60例,随机分为对照组(C 组)和神经阻滞组(N 组),每组各30例。N 组行股神经和股外侧皮神经阻滞,两组均实施常规诱导全麻及静吸复合维持,分别在神经阻滞前、止血带释放前、后不同时间点抽取静脉血测定血丙二醇和次黄嘌呤的水平。记录止血带充气前、止血带充气后、放气后不同时间点的收缩压、舒张压和心率；术后两天的 VAS 评分,记录术后不良反应的发生率。结果：与 C 组比较,X0时两组 MDA、HPX 差异无统计学意义；X1~X3时 N 组 MDA、HPX 明显降低(P <0.05)。T0、T1时两组 SBP、DBP、HR 差异无统计学意义；T2~T6时 N 组 SBP、DBP、HR、MAP 降低(P <0.05)；N 组术后两天 VAS 评分显著性降低(P <0.05)。N 组术后不良反应发生降低。结论：股神经和股外侧皮神经联合阻滞可有效减少止血带反应的发生,减轻缺血再灌注的损伤,术后镇痛效果较好,不良反应少。%Objective:To evaluate the effects of femoral and lateral femoral cutaneous nerve block com-bined with general anesthesia on tourniquet reaction and tourniquet-induced ischemia-reperfusion injuries dur-ing lower ex-tremity surgery.Methods:Sixty ASAⅠorⅡpatients were randomly divided into 2 groups:con-trol group (group C)and nerve block group (group N).Patients in group N underwent femoral nerve block combined with lateral femoral cutaneous nerve block.Both groups were induced by routine general anesthesia method.Blood samples were got respectively before the nerve block,different times before and after tourni-quet release .Including propylene glycol (MDA)and hypoxanthine (HPX)level.SBP、DBP and HR were re-corded before the start of tourniquet inflation and different times after tourniquet deflation.The VAS pain score after the operation and the incidence of the side effects were observed.Results:Compared with the group C,HPX,MDA was not statistically significant at X0 ;but was significantly lower than N group at X1~X3 (P <0.05).No significant difference in SBP,DBP and HR between two groups at T0 ,T1 (P >0.05 ). SBP,DBP and HR in group N were significantly lower at T2 ~T6 (P <0.05).The VAS pain score in group N were significantly lower(P <0.05).The incidence of side effects in group N were lower(P <0.05).Conclu-sion:For patients undergoing lower limb surgery with general anesthesia,femoral nerve block combined with lateral femoral cutaneous nerve block attenuate the tourniquet reaction,reduce the opioid consumption, lessen the injury of ischemia reperfusion injury,enhance the postoperative analgesia,decrease the postopera-tive side effects and promote the postoperative rehabilitation exercise.