超声引导下股神经与坐骨神经联合阻滞在抗凝患者大隐静脉高位结扎与剥脱术中的应用

目的 评价超声引导下股神经与坐骨神经联合阻滞用于抗凝患者行大隐静脉剥脱与高位结扎术的可行性。方法 顺序选择行单侧大隐静脉剥脱与高位结扎术的抗凝患者（NB组）和非抗凝患者（CSEA组）各30例，抗凝患者采用超声引导下股神经与坐骨神经联合阻滞麻醉，非抗凝患者采用腰硬联合麻醉。观察两组麻醉效果、血压变化、输液量、局麻药用量和术后并发症情况。结果 两组患者均顺利完成麻醉与手术，两种麻醉方法成功率均为100%。麻醉后，NB组患者比CSEA组患者的血压平稳（P<0.01）；NB组无需应用升压药，CSEA组有7例静注盐酸麻黄碱；NB组术中平均输液量少于CSEA组［(878±68) mL vs (1226±269) mL，P<0.01］；NB组、CSEA组患者每例使用罗哌卡因的量分别为150mg和15mg。NB组患者术后无恶心呕吐和尿潴留等并发症，CSEA组术后8例发生恶心呕吐，5例因尿潴留而导尿。结论 超声引导下股神经与坐骨神经联合阻滞麻醉可以完全满足抗凝患者大隐静脉剥脱加高位结扎手术的麻醉要求。

Application of ultrasound-guided combined femoral-sciatic nerve block in patients treated with anticoagulants undergoing ligation and stripping of great saphenous vein

Objective To evaluate the feasibility of ultrasound-guided combined femoral-sciatic nerve block for patients treated with anticoagulants before operation undergoing the high ligation and stripping of great saphenous vein. Methods Thirty anticoagulated patients(NB group) and 30 normal coagulation patients(CSEA group) scheduled for unilateral ligation and stripping of great saphenous vein were consecutively chosen in the study. The patients in NB group were operated under ultrasound-guided combined femoral-sciatic nerve block，while the patients in CSEA group were operated under combined spinal and epidural anesthesia.Anesthesia effects, intravenous fluid volume, dosages of local anesthetic, changes of blood pressure and postoperative complications were observed in the two groups. Results The anesthesia and operation procedures were all successful for all patients in both groups. Both of the success rates in the two groups were 100%. During anesthesia, blood pressure in NB group was more stable than that in CSEA group (P<0.01). Seven patients in CSEA group were treated with ephedrine for low blood pressure while no patient in NB group needed vasoconstrictor. Average intravenous fluid volume in NB group was less than that in CSEA group［(878±68) mL vs (1226±269) mL, P<0.01］. Average ropivacaine dosages in NB and CSEA group were 150 mg and 15 mg, respectively. Eight patients suffered from postoperative nausea and vomit and 5 patients suffered from urinary retention in CSEA group, while no patient suffered those symptoms in NB group. Conclusion Ultrasound-guided combined femoral-sciatic nerve block may totally meet the anesthetic requirement of patients treated with anticoagulants undergoing high ligation and stripping of great saphenous vein.