| 摘要: |
| 目的 探讨区域神经阻滞技术在未来下肢战伤麻醉救护中的价值。方法 模拟下肢战伤麻醉处理方式，为58例下肢开放性胫腓骨骨折患者外固定支架固定及清创实施麻醉。经抗休克稳定后，将拟接受手术救治的患者随机分入P组和S组，各29例。P组患者采用神经阻滞技术，在超声引导下实施髂筋膜和坐骨神经联合阻滞后行清创和骨折固定手术；S组则采用传统的椎管内麻醉（蛛网膜下隙阻滞复合硬膜外麻醉）方法，麻醉后接受相同的手术救治。分析比较两组患者的一般情况、术中麻醉意外发生情况、麻醉效率、麻醉后持续镇痛时间和患者整体感受（视觉模拟评分）。结果 术前两组患者一般情况的差异无统计学意义。实施麻醉后，S组有20例（71%）患者循环不稳定、2例（7%）患者呼吸困难，经麻醉医师处理后稳定（1例因插管改全麻退出研究），而P组患者无一例发生麻醉并发症；P组患者从入手术室到手术前的麻醉时间短于S组（P<0.01），同时P组患者输液量低于S组（P<0.01）；术后P组麻醉镇痛时间长于S组（P<0.01）；患者整体感受提示P组患者从麻醉开始直至术后的舒适度优于S组（P<0.01）。结论 从安全性和整体舒适度方面比较创伤胫腓骨骨折患者的麻醉处理方式，区域神经阻滞技术优于传统的椎管内麻醉方式。 |
| 关键词: 外周神经阻滞 椎管内麻醉 野战麻醉 腿损伤 |
| DOI：10.16781/j.0258-879x.2016.11.1406 |
| 投稿时间：2016-02-11修订日期：2016-08-17 |
| 基金项目:第二军医大学军事医学专项课题（2013JS17）. |
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| Application of peripheral nerve block in anesthesia management of patients with trauma of the tibia and fibula |
| MA Yu1,SU Jia-can2,CHEN Jian-fang2,DENG Xiao-ming1* |
(1. Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To explore the value of peripheral nerve block for anesthesia management in patients with lower extremity injuries, so as to discuss its role in future war injury. Methods Totally 58 patients with open fracture of the lower limbs were anesthetized for external fixation and debridement, with the procedure simulating the anesthesia of war extremity injury management. After antishock treatment, the patients were randomly divided into Group P and Group S, with 29 in each group. Patients in Group P were anesthetized using fascia iliaca block combined with sciatic nerve block under ultrasound guidance, and spinal-epidural anesthesia was used in Group S. The general condition of patients, anesthesia complications, anesthesia efficiency, analgesia duration after anesthesia and patients overall satisfaction (VAS score) were compared between the two groups. Results There was no significant difference between the two groups in the general condition before anesthesia. After anesthesia, 20 patients (71%) in Group S suffered circulatory collapse and 2 patients (7%) in Group S suffered respiratory depression, and their conditions were stable (only with 1 patient dropped off due to intubation after anesthesiologist treatment). While no anesthesia complication occurred in Group P. Patients in Group P had a significantly shorter pre-operative anesthesia time than that in Group S (P<0.01), and intra-operative infusion volume in Group P was lower than that in Group S (P<0.01). The post-operative analgesia time in Group P was significantly longer than that in Group S (P<0.01). The overall satisfaction and analgesia effect of patients in Group P was better than those in Group S (P<0.01). Conclusion Peripheral nerve block anesthesia technique is safer and more comfortable than traditional spinal-epidural anesthesia for patients with trauma of the tibia and fibula. |
| Key words: peripheral nerve block epidural anesthesia military anesthesia leg injuries |
