摘要目的 比较超声引导下肢神经阻滞和腰麻用于踝部手术的麻醉效果.方法 经医院伦理委员会批准并与患者签署知情同意书后,选取2014年12月至2015年5月温州医科大学附属第五医院择期行踝部手术患者80例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,年龄18～70岁,根据随机数字表法将患者随机分为2组(n=40):下肢神经阻滞组(N组)与腰麻组(S组).N组在超声引导下行股神经、闭孔神经、股外侧皮神经和骶丛联合阻滞;S组于L3～L4间隙行腰麻.记录麻醉准备及操作时间(Tr)、感觉完全阻滞时间(Tfb)、运动完全阻滞时间(Tmb)、感觉恢复时间(Tfr)、运动恢复时间(Tmr)、麻醉后30 min内低血压和术后24h补救镇痛发生率;评估麻醉效果.结果 N组患者Tr 、Tfb、Tmb、Tfr、Tmr分别为(15.0±1.5)、(11.2±1.2)、(13.4±1.4)、(816.0±112.9)、(432.0±138.9)min,显著长于S组的(8.7±1.2)、(2.3±0.6)、(3.8±1.1)、(436.7±130.5)、(320.0±34.6)min,差异均有统计学意义(t=20.742、41.945、34.101、13.901、4.948,均P＜0.05);两组患者麻醉后30 min内低血压的发生率(0比7.5％)差异无统计学意义(P＞0.05);N组术后24h补救镇痛发生率(45.0％比77.5％)较S组降低,差异有统计学意义(P＜0.05);与S组比较,N组麻醉效果达Ⅰ级的比例(95％比100％)组间比较差异无统计学意义(P＞0.05).结论 超声引导下联合神经阻滞可安全有效地用于踝部手术麻醉,且术后镇痛时间长于腰麻.

abstractsObjective To compare the anesthesia effect between ultrasound-guided lower extremity nerve block and spinal anesthesia in ankle surgery.Methods Upon the approval of institutional Ethics Committee and informed consent,80 patients American Society of Anesthesiology (ASA) Ⅰ-Ⅱ aged 18-70 yr,undergoing ankle surgery from December 2014 to May 2015 in the Fifth Affiliated Hospital of Wen Zhou Medical College,were randomly divided by random numbers into two groups (n =40):nerve block group (group N) and spinal anesthesia (group S).The group N was combined with ultrasound-guided femoral nerve,obturator nerve,lateral femoral cutaneous nerve and sacral plexus block;group S was selected spinal anesthesia in the gap of L3-L4.Times of anesthesia procedure (Tr),sensory block (Tfh),motor block (Tmb),duration of sensory block (Tfr) and duration of motor block (Tmr) were recorded.The incidence of hypotension within 30 min after anesthesia and 24 hours postoperatively analgesic were also recorded.The effect of anesthesia was evaluated.Results The Tr,Tfb,Tmb,Tfr and Tmr in group N and group S were (15.0±1.5),(11.2±1.2),(13.4±1.4),(816.0 ±112.9),(432.0 ± 138.9)min and (8.7 ± 1.2),(2.3 ± 0.6),(3.8 ± 1.1),(436.7 ± 130.5),(320.0 ± 34.6) min,respectively.Tr,Tfb,Tmb,Tfr and Tmr in group N were significantly longer than that in group S (t =20.742,41.945,34.101,13.901,4.948,all P ＜0.05).There was no significant difference in the incidences of hypotension within 30 min after anesthesia (0 vs 7.5％,P ＞ 0.05).The incidence of 24 hours postoperatively analgesic in group N were significantly lower than that in group S (45.0％ vs 77.5％.P＜0.05).Compared with group S,there was no significant difference in the percentage of anesthetic effect reached grade Ⅰ (95％ vs 100％,P ＞ 0.05) in group N.Conclusion Ultrasound-guided nerve block could be safe and effective in patients undergoing ankle surgery,and postoperative analgesia time of nerve block is longer than that of spinal anesthesia.