CAJ | 학술논문

目的：观察超声联合神经刺激仪引导窝坐骨神经、股神经及追加隐神经阻滞后在膝关节以下手术的临床效果，探讨其临床应用的优缺点。方法择期行膝部以下手术患者60例，ASA 分级Ⅰ～Ⅲ级，年龄20～75岁。采用随机数字表法将其分为两组（n ＝30）：A 组超声联合神经刺激仪引导窝坐骨神经、股神经和隐神经阻滞，B 组则仅阻滞窝坐骨神经、股神经。记录阻滞前（T0）、阻滞后10 min（T1）、30 min（T2）、术毕（T3）的收缩压（SBP）、舒张压（DBP）、心率（HR）；记录神经阻滞完成时间、阻滞起效时间、术中舒芬太尼使用率及术后第1次使用镇痛药时间和患者满意度。结果两组患者年龄、性别、体重、ASA 分级及手术时间比较差异无统计学意义。A 组起效时间较 B 组明显缩短（P ＜0．05）；B 组术中舒芬太尼使用率要明显高于 A 组；且 A 组患者术后第1次使用镇痛药时间较 B 组明显延长（P ＜0．05）；A 组满意度比 B 组显著提高（P ＜0．05）。结论超声联合神经刺激仪引导窝坐骨神经、股神经阻滞应用于膝关节以下手术，定位准确，操作简单，血流动力学稳定且并发症少；若追加隐神经阻滞，则能缩短起效时间，镇痛更加完善，延长术后镇痛时间，患者满意度高，是一种更好的麻醉选择。
목적：관찰초성연합신경자격의인도와좌골신경、고신경급추가은신경조체후재슬관절이하수술적림상효과，탐토기림상응용적우결점。방법택기행슬부이하수술환자60례，ASA 분급Ⅰ～Ⅲ급，년령20～75세。채용수궤수자표법장기분위량조（n ＝30）：A 조초성연합신경자격의인도와좌골신경、고신경화은신경조체，B 조칙부조체와좌골신경、고신경。기록조체전（T0）、조체후10 min（T1）、30 min（T2）、술필（T3）적수축압（SBP）、서장압（DBP）、심솔（HR）；기록신경조체완성시간、조체기효시간、술중서분태니사용솔급술후제1차사용진통약시간화환자만의도。결과량조환자년령、성별、체중、ASA 분급급수술시간비교차이무통계학의의。A 조기효시간교 B 조명현축단（P ＜0．05）；B 조술중서분태니사용솔요명현고우 A 조；차 A 조환자술후제1차사용진통약시간교 B 조명현연장（P ＜0．05）；A 조만의도비 B 조현저제고（P ＜0．05）。결론초성연합신경자격의인도와좌골신경、고신경조체응용우슬관절이하수술，정위준학，조작간단，혈류동역학은정차병발증소；약추가은신경조체，칙능축단기효시간，진통경가완선，연장술후진통시간，환자만의도고，시일충경호적마취선택。
Objective To assess the advantages and disadvantages of popliteal fossa sciatic nerve,the femoral nerve and saphenous nerve block guided by ultrasound,compared the method without saphenous nerve block in pa-tients undergoing the surgery below knee.Methods Sixty patients (ASA Ⅰ ~Ⅲ)scheduled for the surgery below knee,age 20 ~75yr,were randomly divided into 2 groups (n =30 each)by random number table.Group A:Pop-liteal fossa sciatic nerve,the femoral nerve and saphenous nerve block guided by ultrasound,group B:Popliteal fossa sciatic nerve,the femoral nerve block guided by ultrasound.SBP,DBP,HR were recorded at before block (T0 ),10 min (T1 )and 30 min after blockade(T2 ),0 min after operation (T3 ).Time of nerve block,onset time of blockade,the rate of rescue sufentanil utilization intraoperative,the time for first rescue analgesic after operation and the rate of patient satisfaction were also recorded.Results Age,sex,weight,grade of ASA and surgery time in two groups were no statistically significant difference.Compared with group B,onset time(5.7 ±1.8min)and the rate of rescue sufentanil utilization intraoperative in group A were significantly decreased.And the time for first rescue analgesic(651.8 ±70.3min)was significantly prolonged in group A (P <0.05).Satisfaction in group A was significantly more than it in group B.The rate of required sufentanil in group A were significantly lower than that in group B (P <0.05).Conclusion The method of popliteal fossa sciatic nerve,the femoral nerve block guided by ultrasound in patients undergoing the surgery below knee has the advantages,including accurate loca-tion,simple procedure,stable hemodynamics and less complications.If saphenous nerve is also blocked,the meth-od would be a better choice for patients undergoing the surgery below knee because it could decrease the onset time,and improve quality of the blockade and satisfaction of patients.