摘要
目的 分析收肌管隐神经阻滞对大隐静脉曲张手术患者术后疼痛和早期活动的影响.方法 纳入60 例行大隐静脉曲张手术患者,随机分成对照组(n=30)和观察组(n=30),对照组行喉罩全身麻醉,观察组在超声引导下行大腿中部入路收肌管隐神经阻滞复合喉罩全身麻醉.比较两组麻醉优良率,以及术前(T0)、手术开始时(T1)、手术开始30 min(T2)、转出手术室时(T3)的血流动力学及术后6、12、24 h的疼痛情况,并记录术后首次下床活动时间和术后恢复质量,统计术后不良反应发生情况.结果 观察组麻醉优良率与对照组比较,差异无统计学意义(χ2=2.07,P＞0.05).T0时,两组患者HR、MAP比较,差异均无统计学意义(t分别=0.67、0.63,P均＞0.05);T1、T2、T3时,观察组HR、MAP均低于对照组,差异均有统计学意义(t分别=5.64、3.11、2.36;2.75、2.83、3.56,P均＜0.05).观察组术后6、12、24 h疼痛视觉模拟评分(VAS)均低于对照组,差异均有统计学意义(t分别=3.10、2.75、4.98,P均＜0.05).观察组术后首次下床活动时间短于对照组,差异有统计学意义(t=10.85,P＜0.05).观察组术后1d的术后恢复质量量表各维度评分明显高于对照组,差异均有统计学意义(t分别=8.88、8.07、3.29、5.74、5.53、14.66,P均＜0.05).观察组不良反应总发生率低于对照组,差异有统计学意义(χ2=4.32,P＜0.05).结论 大隐静脉曲张手术应用收肌管隐神经阻滞,在保持血流动力学稳定及减少术后疼痛方面具有显著优势,对早期活动影响较小,可促进术后恢复,且安全性良好.
Abstract
Objective To analyze the effect of saphenous nerve block at the adductor canal on postoperative pain and early activity of patients undergoing operation for great saphenous varicose veins.Methods Using the random number table method,60 patients who were scheduled to undergo operation for great saphenous varicose veins were divided into the control group(n=30)and the observation group(n=30).The control group received general anesthesia via laryngeal mask airway,while the observation group received ultrasound-guided saphenous nerve block at the adductor canal via middle thigh approach combined with general anesthesia via laryngeal mask airway.The two groups were compared in terms of excellent and good rate of anesthesia,hemodynamics before operation(T0),at the beginning of operation(T1),30 minutes after the beginning of operation(T2)and out of the operating room(T3),and VAS score at 6,12,24 hours after surgery.The postoperative first out-of-bed activity time and postoperative recovery quality were recorded as well.The incidence rates of postoperative adverse reactions were calculated.Results The excellent and good rate of anesthesia be-tween two groups was not statistically different(χ2=2.07,P＞0.05).At T0,there was no statistically significant difference in HR and MAP between the two groups of patients(t=0.67,0.63,P＞0.05).At T1,T2,and T3,the HR and MAP of the observation group were lower than those of the control group,and the differences were statistically significant(t=5.64,3.11,2.36,2.75,2.83,3.56,P＜0.05).The VAS scores of the observa-tion group were lower than those of the control group at 6,12,and 24 hours after surgery,and the differences were statistically significant(t=3.10,2.75,4.98,P＜0.05).The first out-of-bed activity time of the observation group after surgery was shorter than the control group,and the differ-ence was statistically significant(t=10.85,P＜0.05).The postoperative recovery quality scale scores of the observation group were significantly higher than those of the control group on first day after surgery,and the differences were statisti-cally significant(t=8.88,8.07,3.29,5.74,5.53,14.66,P＜0.05).The total incidence of adverse reactions in the observa-tion group was lower than that in the control group,and the difference was statistically significant(χ2=4.32,P＜0.05).Conclusion Applying saphenous nerve block at the adductor canal in the operation for great saphenous varicose veins can maintain hemodynamic stability and reduce postoperative pain,with little influence on early activities.Meanwhile,it can promote postoperative recovery.
维普
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