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超声引导下股神经-坐骨神经联合阻滞麻醉与连续硬膜外麻醉用于胫腓骨骨折手术麻醉效果的比较
Application Comparison of Different Sciatic Nerve Block Combined with Femoral Nerve Block under the Guidance of Ultrasound and Continuous Epidural Anesthesia in Internal Fixation of Tibiofibula Fractu

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DOI:
作者:
姚滢，蒋平，岑奕，夏建华
Yao Ying, Jiang Ping, Cen Yi, Xia Jianhua
作者单位:
上海市虹口区解放军第411医院麻醉科
Department of Anesthesia Management, 411 Hospital,Hongkou District, Shanghai,
关键词:
超声引导；坐骨神经阻滞；胫腓骨骨折手术；麻醉满意度；镇痛时间；术后下肢运动恢复度
ultrasound guidance; sciatic nerve block; femoral nerve block; hemodynamic change degree; satisfaction index of anesthesia; analgesic maintenance time; lower limbs sensory extinction
摘要:
摘要：目的：为评估超声引导下股神经-坐骨神经联合阻滞麻醉在胫腓骨骨折手术中的麻醉效果提供临床依据和参考。方法：对90例胫腓骨骨折切开复位内固定手术患者随机分为3组：A组行超声引导下坐骨结节水平股神经-坐骨神经联合阻滞麻醉，B组行超声引导下腘窝处股神经-坐骨神经联合阻滞麻醉，C组行连续硬膜外麻醉；监测3组患者术中HR、BP、SpO2的改变；评估血流动力学改变度、麻醉满意度、镇痛时间、及术后下肢运动恢复度等指标。应用Mann-Whitney U检验比较3组患者间上述指标的差异。结果： Mann-Whitney U检验结果表明，与C组相比，A组的麻醉满意度、镇痛时间、术后下肢运动恢复度均有显著差异（all P<0.01)。与C组相比，B组的血流动力学改变度、镇痛时间、术后下肢运动恢复度均有显著差异（all P<0.01)。与B组相比，A组仅麻醉满意度有显著性差异（P<0.01）。结论：在超声引导下实施股神经-坐骨神经联合阻滞麻醉能有效减少麻醉后遗症和并发症的发生，且该方法不会造成神经干损害。腘窝处行股神经-坐骨神经联合阻滞麻醉的麻醉方法对膝部及以下各类手术麻醉效果最优。
Abstract:Objective: This investigation provides clinical basis and reference datas for application of sciatic nerve block combined with femoral nerve block under the guidance of ultrasound. Methods: 90 patients were initially selected for the investigation with tibiofibula fracture open reduction and internal fixation operation and divided into 3 groups. Patients in Group A did an anesthesia of sciatic nerve combined with femoral nerve block under the guidance of ultrasound; in Group B did an anesthesia of popliteal fossa sciatic nerve and femoral nerve block under the guidance of ultrasound;in Group C did the continuous epidural block. By monitoring HR，BP，SpO2 in operations in three groups, this investigation compares hemodynamic change degree.In addition,other index were detected including satisfaction index of anesthesia, analgesic maintenance time and lower limbs sensory extinction. Mann-Whitney U test was used to compare numerical variables in 3 groups.Results: In three groups, Mann-Whitney U test results show that compared with Group C, hemodynamic change degree has no significant differences in Group A （P>0.01),and satisfaction index of anesthesia,analgesic maintenance time and limbs sensory extinction in Group A have significant differences（all P<0.01). Compared with Group C, hemodynamic change degree in Group B is smaller,（P<0.01), and satisfaction index of anesthesia has no significant differences（P>0.01), accompanied by quicker analgesic maintenance time（P<0.01), lower limbs sensory extinction（P<0.01). In addition, hemodynamic change degree, analgesic maintenance time and lower limbs sensory extinction in Group A have no significant differences compared with those in Group B（P>0.01). However, satisfaction index of anesthesia in Group A is lower than in Group B（P<0.01). Conclusion: Anesthesia methods of sciatic nerve block combined with femoral nerve block under the guidance of ultrasound apply to all kinds of operations of the knee and knee belowing, especially for patients of intraspinal anesthesia and elderly with poor heart and lung function. Furthermore, this method makes no neural stem damage and reduces the occurrence of anesthetic sequelae and complications effectively.

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