摘要
目的比较超声引导下股神经阻滞复合喉罩全身麻醉与单纯喉罩全身麻醉以及连续硬膜外麻醉对大隐静脉高位结扎加点式剥脱术患者术后镇痛和早期下床活动的影响。方法择期拟行单侧大隐静脉高位结扎加点式剥脱术患者60例。随机分为3组（n=20），硬膜外阻滞组（A组）；单纯喉罩全身麻醉组（B组）和超声引导下股神经阻滞复合喉罩全身麻醉组（C组）。记录术后1h和3hVAS评分；记录患者术后首次下床活动时间；记录术后24h内麻醉并发症：包括呼吸抑制、咽喉疼痛、尿潴留、寒战、腰背部穿刺点疼痛、神经损伤和穿刺部位血肿形成，并在出院前随访患者，记录患者对此次麻醉的满意度评价。结果与硬膜外麻醉组比较，超声引导下股神经阻滞复合喉罩全身麻醉组，术后1h和3h视觉模拟评分法（VAS）评分差异无统计学意义（P〉0．05）；但患者术后首次下床活动时问方面，超声引导下股神经阻滞复合喉罩全身麻醉组为（3．57±0．68）h，较硬膜外麻醉组的（5．46±0．76）h明显提早（P〈0．05）；在患者对此次麻醉的满意度评价方面，超声引导下股神经阻滞复合喉罩全身麻醉组（6．95±1．47）分，较硬膜外麻醉组的（4．85±1．35）分明显提高（P〈0．05）。与单纯喉罩全身麻醉组比较，超声引导下股神经阻滞复合喉罩全身麻醉组患者术后首次下床活动时间轻微延迟，但差异无统计学意义；术后1h和3hVAS评分方面，超声引导下股神经阻滞复合喉罩全身麻醉组（2．1±1．4）分和（2．9±1．3）分，较单纯喉罩全身麻醉组的（5．9±1．1）分和（5．6±1．5）分，均明显降低（P〈0．05）；患者对此次麻醉的满意度评价方面，超声引导下股神经阻滞复合喉罩全身麻醉组6．95±1．47分，较单纯喉罩全身麻醉组的（4．35±1．53）分明显升高（P〈0．05）。结论大隐静脉高位结扎加点式剥脱术选择超声引导下股神经阻滞复合喉罩全身麻醉，有利于下肢静脉曲张患者术后早期下床活动，并且术后早期镇痛效果良好，患者满意度高。
Objective To evaluate the efficacy of ultrasound - guided femoral nerve block com- pound with laryngeal mask anesthesia on postoperative analgesia and early lower limb movement in patients after varicose vein surgery. Methods Sixty patients undergoing the surgery of high ligation and stripping of great saphenous vein on an elective day, were randomized into three groups （n = 20 each） ： continuous epi- dural anesthesia group （ group A）, laryngeal mask anesthesia group （ group B ）, and ultrasound - guided femoral nerve block compound with laryngeal mask anesthesia group （ group C）. Pain visual analogue score （VAS） on postoperative 1 and 3 h, the first time to walk upright, anaesthetic complications and patients＇ satisfaction degree were recorded in three groups. Results There was no significant difference in VAS be- tween group A and group C on postoperative 1 and 3 h （ P 〉 0.05 ）. The first time to walk upright was sig- nificantly decreased from （5.46 ±0.76） h in group A to （3.57 ±0.68） h in group C （P〈0.05）. Patients ＇ satisfaction degree was significantly increased from 4. 85 ± 1.35 in group A to 6. 95 ± 1.47 in group C （P 〈0. 05）. There was no significant difference in the first time to walk upright between group B and group C （ P 〉 0. 05 ）. VAS on postoperative 1 and 3 h was significantly decreased from 5.9 ± 1.1 points and 5.6 ± 1.5 points in group B respectively, to 2. 1 ± 1.4 points and 2. 9 ± 1.3 points in group C （P 〈 0. 05 ,P 〈0. 05 ）. The patients＇ satisfaction degree was significantly increased from 4. 35 ± 1.53 points in group B to 6. 95 ± 1.47 points in group C （ P 〈 0. 05 ）. Conclusion Ultrasound - guided femoral nerve block compound with laryngeal mask anesthesia can supply good postoperative analgesia and help to walk upright early with less complications and higher satisfaction degree in patients after varicose vein surgery.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2015年第12期3157-3159,共3页
Chinese Journal of Experimental Surgery
基金
福建省医学创新科研基金资助项目（2012-CX-21）
关键词
股神经阻滞
超声检查
镇痛
静脉曲张
Femoral nerve block
Ultrasonography
Analgesia
Varicose veins
作者简介
通信作者：林献忠，Email：1518504602@qq．com
