收肌管及腘窝坐骨神经阻滞联合踝部止血带在老年足部手术的应用

Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery

摘要:

目的 探讨收肌管及腘窝坐骨神经阻滞联合踝部止血带在老年足部手术应用的效果。方法 择期行足部手术的老年患者69例，以随机数字表法分为3组：蛛网膜下腔阻滞联合大腿止血带组（C组）、蛛网膜下腔阻滞联合踝部止血带组（SA组）及收肌管及腘窝坐骨神经阻滞联合踝部止血带组（NA组）。比较3组麻醉后30 min内平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）变化峰值，松止血带后1、3、5、10、15 min时MAP及HR变化；术后排尿、排气时间及24 h恢复质量（quality of recovery，QoR）-15评分；麻醉及术野止血效果、间羟胺用量、首次自控镇痛（patient-controlled analgesia，PCA）时间、术后48 h内舒芬太尼用量及不良反应等情况。结果 纳入患者69例，64例完成研究。与C组及SA组比较，NA组麻醉后30 min内MAP及HR变化峰值明显减小，术后排尿、排气时间显著缩短，24 h QoR-15评分更高；麻醉起效较慢、阻滞范围小，间羟胺用量更少，首次PCA时间显著延长，术后12、24及48 h舒芬太尼累积用量减少，差异有统计学意义（P<0.05）。与C组比较，SA组及NA组松止血带后MAP、HR波动幅度明显减小，间羟胺用量更少；术后止血带区域皮肤水泡和疼痛发生率更低，差异有统计学意义（P<0.05）。3组其余指标差异无统计学意义（P>0.05）。结论 收肌管及腘窝坐骨神经阻滞联合踝部止血带应用于老年足部手术，血流动力学稳定，恢复速度快，效果良好，不良反应少。

Abstract:

Objective To investigate the effects of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery.Methods Sixty-nine elderly patients，scheduled for elective foot surgery，were randomized into 3 groups：subarachnoid block combined with thigh tourniquet group（group C），subarachnoid block combined with ankle tourniquet group（group SA），adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet group（group NA）. The peak changes of mean arterial pressure（MAP） and heart rate（HR） during 30 min after anesthesia，and changes of MAP and HR at 1 min，3 min，5 min，10 min and 15 min after tourniquet deflation；postoperative micturition and flatus passage time，quality of recovery-15（QoR-15） score 24 h after operation；effects of anesthesia and surgical field hemostasis，dose of metaraminol，time of patient-controlled analgesia（PCA） initiation and consumption of sufentanil within 48 h after operation and adverse reactions were compared among the three groups.Results Sixty-nine patients were enrolled in the study，and sixty-four completed the study. Compared with group C and group SA，the peak changes of MAP and HR during 30 min after anesthesia of group NA were significantly lower. In addition， the postoperative micturition and flatus passage time were shortened，and QoR-15 score 24 h after operation was higher. The onset of anesthesia was slower，region of blockade was smaller，less metaraminol was used，time of PCA initiation was longer，and cumulative consumptions of sufentanil were less at 12 h，24 h and 48 h after operation in group NA. All the differences were statistically significant（P<0.05）. Compared with group C，the amplitudes of MAP and HR changes in group SA and group NA after tourniquet deflation were significantly smaller with less metaraminol. Moreover，the incidences of skin blisters and pain in tourniquet area were significantly lower after operation（P<0.05）. There were no significant differences in other indexes among the three groups（P>0.05）.Conclusion Applications of adductor canal and popliteal sciatic nerve blocks combined with ankle tourniquet in elderly foot surgery could bring stable hemodynamics，enhanced recovery， favorable effects and few adverse reactions.