2018 年第 1 期 第 13 卷

超声引导下侧入路腘窝坐骨神经联合股神经阻滞在老年糖尿病足手术中的麻醉效果

作者：马冬梅尚志刚徐桂萍

英文作者：

单位：830001乌鲁木齐，新疆维吾尔自治区人民医院麻醉科

英文单位：

关键词：腘窝坐骨神经阻滞；糖尿病足；Semmes-Weinstein单丝检测

英文关键词：

• 摘要：

• 【摘要】目的    探讨超声引导下侧入路腘窝坐骨神经联合股神经阻滞在老年糖尿病足手术中的麻醉效果及对循环系统的影响。方法    选取2015年8月至2016年2月新疆维吾尔自治区人民医院择期行糖尿病足部手术的老年患者60例，应用随机数字表分为腘窝坐骨神经联合股神经阻滞组（PF组）和硬膜外麻醉组（E组），每组30例。记录2组患者麻醉前以及麻醉后10、15、20、30、60 min的收缩压、舒张压、心率，采用Semmes-Weinstein单丝检测法检测2组患者感觉和运动神经阻滞的起效时间和维持时间，记录不良反应的发生情况。结果    PF组1例患者因术中改变手术方式而改变麻醉方法从本研究中剔除。血流动力学指标比较：麻醉前2组患者的收缩压、舒张压、心率比较差异均无统计学意义(均P>0.05)，E组在麻醉后10、15、20 min的收缩压、舒张压较麻醉前明显下降，且明显低于PF组(均P<0.05)。2组患者感觉神经阻滞及运动神经阻滞的起效时间比较差异均无统计学意义(均P>0.05)，PF组感觉神经阻滞和运动神经阻滞的维持时间均明显长于E组［（523±82）min比（354±67）min，（377±52）min比（259±54）min］(均P<0.01)。E组与PF组不良反应发生率分别为63.3%（19/30）、3.4%（1/29），组间比较差异有统计学意义(P<0.05)。结论    超声引导下侧入路腘窝坐骨神经联合股神经阻滞用于老年糖尿病足部手术麻醉效果确切，血流动力学稳定，且不良反应少。

• Anesthetic effect of ultrasound-guided lateral approach popliteal sciatic nerve combined with femoral nerve block on senile diabetic foot surgery

  Ma Dongmei, Shang Zhigang, Xu Guiping

  Department of Anesthesiology, People′s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China

  Corresponding author: Xu Guiping, Email: xgpxyl@126.com

  【Abstract】Objective     To explore the effect of ultrasound-guided lateral approach popliteal sciatic nerve combined with femoral nerve block anesthesia on senile diabetic foot surgery and circulatory system. Methods    Sixty senile patients undergoing diabetic foot surgery from August 2015 to February 2016 in People′s Hospital of Xinjiang Uygur Autonomous Region were randomly divided into popliteal sciatic nerve combined with femoral nerve block group（PF group） and epidural anesthesia group（E group）, with 30 cases in each group. Systolic pressure, diastolic pressure and heart rate were recorded before and 10, 15, 20, 30, 60 min after anesthesia. Sensory and motor nerve block onset time and maintaining time were monitored by the Semmes-Weinstein monofilaments test. Occurrence of adverse reactions was observed. Results    One case in PF group was eliminated because of change of anesthesia method during operation. There were no significant differences of systolic pressure, diastolic pressure and heart rate before anesthesia between groups(P>0.05). Systolic pressure, diastolic pressure 10、15、20 min after anesthesia in E group were significantly lower than those before anesthesia and those in PF group(P<0.05). There were no significant differences of sensory nerve block onset time and motor nerve block onset time between groups(P>0.05). Sensory nerve block maintaining time and motor nerve block maintaining time in PF group were significantly longer than those in E group［（523±82）min vs （354±67）min, （377±52）min vs （259±54）min］(P<0.01). Incidence of adverse reactions was 63.3%（19/30） in E group and 3.4%（1/29） in PF group; there was a significant difference between groups(P<0.05). Conclusion    Ultrasound-guided lateral approach popliteal sciatic nerve combined with femoral nerve block has a good anesthetic effect on senile patients with diabetic foot surgery without unstable hemodynamic fluctuation and side reactions.

  【Key words】Popliteal sciatic nerve block;Diabetic foot;Semmes-Weinstein monofilaments