目的 探究连续腘窝上坐骨神经阻滞联合隐神经阻滞在老年糖尿病足患者软组织切开清创引流中的应用。方法 选取2022年1月—2023年12月于我院进行糖尿病足手术治疗的患者90例作为研究对象,随机分为对照组、研究组,每组45例。对照组：给予单次腘窝上坐骨神经阻滞。研究组：给予连续腘窝上坐骨神经阻滞联合隐神经阻滞。采用视觉模拟评分量表（Visual Analogue Scale,VAS）评分量表、症状自评量表（Symptom Checklist-90,SCL-90）评估患者自身疼痛程度及心理状态情况;统计感觉阻滞起效时间、感觉阻滞维持时间、运动阻滞起效时间、运动阻滞持续时间;测量溃疡面积、创面渗出量;检测患者收缩压（systom blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、心率（heart rate,HR）、CD3+、CD4+、CD4+/CD8+水平情况;检测胫神经、腓总神经传导速度。对比两组不良反应发生率。结果 术后1周、2周,相比于对照组,研究组VAS评分、SCL-90评分水平、溃疡面积、创面渗出量显著降低;相比于对照组,研究组感觉阻滞起效时间缩短,感觉阻滞维持时间、运动阻滞持续时间延长;麻醉前（before anesthesia,Tb）、麻醉后5 min（5 min,T5）、麻醉后10 min（10 min,T10）、麻醉后15 min（15 min,T15）、麻醉后30 min（30 min,T30）各时间DBP、SBP水平,研究组均降低（P<0.05）;术后,相比于对照组,研究组CD3+、CD4+、CD4+/CD8+水平显著降低,胫神经、腓总神经传导速度显著升高。结论 连续腘窝上坐骨神经阻滞联合隐神经阻滞对老年糖尿病足患者组织切开清创引流中,能提高整体麻醉效果,减轻溃疡面积,降低创面渗出量,改善血流动力学,提高免疫功能,从而促进术后恢复,安全性较高。
Abstract
Objective To explore the application of continuous superior popliteal sciatic nerve block combined with saphenous nerve block for incision debridement and drainage of soft tissue in elderly diabetic foot patients. Methods From January 2022 to December 2023, 90 patients were selected for diabetic foot surgery in our hospital and divided into control group and study group, with 45 cases in each group. Control group: a single superior popliteal sciatic nerve block was given. Study group: Continuous popliteal sciatic nerve block combined with crypenous nerve block. Visual Analogue Scale (VAS) and Symptom Checklist-90 (SCL-90) were used to assess the pain and psychological status; the onset of sensory block, the duration of motor block and the duration of motor block; and the ulcer area and wound exudation; the levels of SBP, DBP, HR, CD3+, CD4+, CD4+ / CD8+; and the conduction velocity of tibial nerve and total peroneal nerve. The incidence of adverse reactions in the two groups was compared. Results One week and two weeks after surgery, compared with the control group, the study group showed significant reductions in VAS score, SCL-90 psychological score, ulcer area, and wound exudation. The study group also exhibited a shorter onset time of sensory block, a longer maintenance time of sensory block, and a prolonged duration of motor block. Regarding hemodynamic parameters, the levels of DBP and SBP at all time points [before anesthesia (Tb), and 5 min (T5), 10 min (T10), 15 min (T15), 30 min (T30) after anesthesia] were significantly lower in the study group than in the control group. Postoperatively, the levels of CD3+, CD4+, and the CD4+/CD8+ ratio were significantly decreased, while the conduction velocity of the tibial nerve and common peroneal nerve was significantly increased. Furthermore, the total incidence of adverse effects was significantly reduced in the study group. Conclusion The continuous popliteal nerve block combined with hidden nerve block can improve the overall anesthesia effect, reduce the ulcer area, reduce the exudation of wound, improve hemodynamics, and improve immune function in the tissue incision and debridement drainage of elderly diabetic foot patients, thus promoting postoperative recovery and having high safety.
关键词
连续腘窝上坐骨神经阻滞 /
隐神经阻滞 /
老年患者 /
糖尿病足 /
清创引流
Key words
continuous superior sciatic nerve block in the popliteal fossa /
saphpous nerve block /
elderly patient /
diabetic foot /
debridement and drainage
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基金
济宁市重点研发计划项目“IF-17A介导自身免疫性损伤对老年糖尿病患者术后儋妄的作用及机制研究”（2022YXNS017）
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