标题：超声引导下腘窝上坐骨神经阻滞在足部手术患者中的应用

      作者：樊林滨，杨荣国    西安凤城医院麻醉科，陕西 西安 710000

      卷次： 2021年32卷5期

      【摘要】 目的 探讨超声引导下腘窝上坐骨神经阻滞在足部手术患者中的应用效果。方法 选取2017年3月至2020年3月拟于西安凤城医院进行足部手术的82例患者作为研究对象，按照随机数表法将所有患者分为观察组和对照组各41例。对照组患者给予硬膜外麻醉，观察组患者给予超声引导下腘窝上坐骨神经阻滞。比较两组患者的麻醉操作时间、运动阻滞与感觉阻滞持续时间、不良反应发生率，以及麻醉前(T0)、麻醉后15 min (T1)、麻醉后30 min(T2)、麻醉后60 min (T3)的心率(HR)及平均动脉压(MAP)，并比较两组患者治疗前后的皮质醇(Cor)、血浆葡萄糖(GLU)和儿茶氨酚(CA)水平。结果 两组患者麻醉操作时间比较差异无统计学意义(P>0.05)；观察组患者的运动阻滞持续时间、感觉阻滞持续时间分别为(307.26±14.38) min、(450.17±20.37) min，明显长于对照组的(190.49±10.17) min、(220.73±13.72) min，差异均具有统计学意义(P<0.05)；观察组患者 T1、T2、T3时MAP分别为(12.83±1.27) kPa、(13.04±1.46) kPa、(13.02±1.42) kPa，明显高于对照组的(11.27±0.89) kPa、(11.36±0.84) kPa、(11.62±0.69) kPa，差异均有统计学意义(P<0.05)；治疗后，观察组患者的CA、Cor、GLU水平分别为(354.11±14.14) ng/L、(324.27±12.82) mmol/L、(5.57±1.24) mmol/L，明显低于对照组的(392.25±15.73) ng/L、(334.73±18.36) mmol/L、(7.62±2.19) mmol/L，差异均有统计学意义(P<0.05)；观察组患者的总不良反应发生率为 19.51%，明显低于对照组的 41.46%，差异有统计学意义(P<0.05)。结论 超声引导下腘窝上坐骨神经阻滞在足部手术患者中的麻醉效果显著，其可延长麻醉持续时间，安全性高，不良反应发生率低，患者应激反应小，值得临床推广应用。
      【关键词】 超声引导；坐骨神经阻滞；腘窝；硬膜外麻醉；应激反应；血流动力学
      【中图分类号】 R687.3 【文献标识码】 A 【文章编号】 1003—6350（2021）05—0624—04

Application of ultrasound-guided suprapopliteal sciatic nerve block in patients undergoing foot surgery.
FANLin-bin, YANG Rong-guo. Department of Anesthesiology, Xi'an Fengcheng Hospital, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To explore the effect of ultrasound-guided suprapopliteal sciatic nerve block in patientsundergoing foot surgery. Methods Eighty-two patients with foot surgery in Xi'an Fengcheng Hospital from March2017 to March 2020 were selected as the research objects. According to the random number table, the patients were di-vided into two groups, with 41 patients in each group. The control group was given epidural anesthesia, and the observa-tion group was given suprapopliteal nerve block under the guidance of ultrasound. The operation time of anesthesia, theduration of motor block, and the duration of sensory block, the incidence of adverse reactions, as well as the heart rate(HR) and mean arterial pressure (MAP) at pre-anaesthesia (T0), 15 minutes after anesthesia (T1), 30 minutes after anes-thesia (T2), and 60 minutes after anesthesia were compared between the two groups. The levels of cortisol (Cor), plasmaglucose (GLU), and catechol (CA) before and after treatment in the two groups were compared. Results There was nosignificant difference in the operation time of anesthesia between the two groups (P>0.05). The duration of motor blockand the duration of sensory block in the observation group were (307.26±14.38) min and (450.17±20.37) min, which