超声引导下股神经结合坐骨神经阻滞对抗凝病人大隐静脉剥脱术的麻醉效果

目的:探讨超声引导下股神经结合坐骨神经阻滞对抗凝病人大隐静脉剥脱术的麻醉效果。方法:选取40例行单侧大隐静脉剥脱术的抗凝病人作为研究对象，采用随机数字表法分为观察组和对照组，各20例。观察组病人采用超声引导下股神经结合坐骨神经阻滞麻醉，对照组病人采用椎管内麻醉。观察2组麻醉阻滞前后血压及心率（HR）变化，记录麻醉起效时间及手术时间，评价2组麻醉效果及术后疼痛程度，比较2组不良反应发生情况。结果:观察组病人麻醉阻滞前后各时点的收缩压（SBP）、舒张压（DBP）及HR指标间差异均无统计学意义（P>0.05）；而对照组病人T2时的SBP、DBP均明显低于T0和T1（P<0.01），T3时SBP、DBP均明显高于T2（P<0.01）。组间比较显示，观察组T2时的SBP、DBP均明显高于同时间点的对照组（P<0.01）。观察组病人术中输液量明显低于对照组（P<0.01）；2组术中升压药物使用差异无统计学意义（P>0.05）。观察组麻醉效果优于对照组（P<0.05）。观察组病人术后不良反应发生率低于对照组（P<0.05）。结论:在抗凝病人大隐静脉剥脱术中采用超声引导下股神经结合坐骨神经阻滞麻醉效果确切，术中血压稳定，输液量少，术后疼痛程度低、不良反应少，值得临床推广应用。

Anesthetic effect of the femoral nerve combined with sciatic nerve block guided by ultrasound in the great saphenous vein stripping in anticoagulation patients

Objective: To investigate the anesthetic effects of femoral nerve combined with sciatic nerve block guided by ultrasound in the great saphenous vein stripping in anticoagulation patients.Methods: Forty anticoagulant patients treated with unilateral great saphenous vein stripping were divided into the observation group and control group according to the random number table method(20 cases each group).The observation group was treated with the femoral nerve combined with sciatic nerve block anesthesia guided by ultrasound,and the control group was treated with spinal anesthesia.The changes of blood pressure and heart rate(HR) in two groups were observed before and after anesthesia block,the onset time and operation time of anesthesia in two groups were recorded,and the anesthetic effect,postoperative pain degree and adverse reactions between two groups were compared.Results: The differences of SBP,DBP and HR in observation group between before and after anesthesia block were not statistically significant(P>0.05).In control group,the SBP and DBP at T2 were significantly lower than those at T0 and T1(P<0.01),and the SBP and DBP at T3 were significantly higher than those at T2(P<0.01).The SBP and DBP in observation group at T2 were significantly higher than those in control group at the same time-point(P<0.01).The intraoperative infusion volume in observation group was significantly lower than that in control group(P<0.01).The difference of the usage rate of intraoperative antihypertensive drug between two groups was not statistically significant(P>0.05).The anesthesia effect in observation group was significantly better than that in control group(P<0.05).The incidence rate of postoperative complications in observation group was lower than that in control group(P<0.05).Conclusions: The application of femoral nerve combined with sciatic nerve block guided by ultrasound in the great saphenous vein stripping in anticoagulation patients has good anesthetic effects,can stabilize the intraoperative blood pressure,has low infusion volume,low postoperative pain degree and little adverse reaction,which is worthy of clinical application.