沙漏征髂筋膜间隙阻滞在老年糖尿病足手术麻醉中的应用研究

Application of iliac fascia space block with hourglass sign in anesthesia of elderly diabetes foot surgery

摘要:

目的 观察沙漏征髂筋膜间隙阻滞在老年糖尿病足手术麻醉中的应用效果。方法 该研究为前瞻性研究，选择南阳医学高等专科学校第一附属医院2022年1月至2022年12月收治的112例老年糖尿病足患者为研究对象，以计算机随机分组法将其列为常规组和试验组，各56例。常规组实施常规全身麻醉，试验组采用沙漏征髂筋膜间隙阻滞辅助麻醉，比较两组患者围手术期基础体征变化，术后镇痛镇静情况，术后苏醒情况，手术应激情况及麻醉安全性。结果 在不同麻醉方案下，试验组气管插管时（T2）、切皮时（T3）、术毕（T4）时的心率（HR）分别为（78.24±10.33）次/min、（79.62±10.48）次/min、（77.49±10.27）次/min，均低于常规组［（83.11±10.61）次/min、（84.25±10.36）次/min、（82.66±10.43）次/min］（P<0.05）；平均动脉压（MAP）分别为（113.64±20.33）mmHg、（115.75±20.61）mmHg、（112.45±20.32）mmHg，均低于常规组［（125.77±20.61）mmHg、（130.45±20.72）mmHg、（128.62±20.33）mmHg］（P<0.05）；试验组术后1 h、3 h、5 h的视觉模拟疼痛量表（VAS）评分分别为（3.88±0.26）分、（3.23±0.45）分、（2.62±0.31）分，均低于常规组［（4.35±1.27）分、（3.79±0.82）分、（3.22±0.85）分］（P<0.05）；Ramsay镇静评分（RSS）分别为（3.83±0.25）分、（3.55±0.46）分、（3.16±0.39）分，均高于常规组［（3.04±0.78）分、（2.52±0.36）分、（1.83±0.85）分］（P<0.05）。试验组的睁眼时间、麻醉恢复室（PACU）停留时间分别为（15.45±3.36）min、（20.44±5.16）min，略高于常规组［（14.29±3.31）min、（19.45±3.46）min］，但差异无统计学意义（P>0.05）；试验组的静脉自控镇痛泵（PCIA）应用时间、住院时间分别为（24.33±5.61）h、（8.28±1.46）d，均低于常规组［（27.62±5.39）h、（10.36±2.72）d］（P<0.05）；试验组术后的去甲肾上腺素（NE）、皮质醇（Cor）分别为（170.25±20.33）pg/mL、（233.45±20.76）ng/mL，均低于常规组［（184.33±20.42）pg/mL、（248.75±20.61）ng/mL］（P<0.05）。试验组的麻醉相关副反应发生率为10.71%（6/56），略高于常规组［7.14%（4/56）］，但差异无统计学意义（P>0.05）。结论 沙漏征髂筋膜间隙阻滞辅助全麻能稳定老年糖尿病足患者围手术期基础体征，可在不影响苏醒情况或增加麻醉风险同时，增强镇痛、镇静效果，并减轻手术应激情况。

Abstract:

Objective To observe the application effect of sandglass sign iliac fascial space block in elderly diabetes foot surgery anesthesia.Methods This study is a prospective study. Totally 112 elderly patients with diabetes foot who were admitted from January 2022 to December 2022 were selected as the study subjects. They were randomly divided into the conventional group (56 cases) and the experimental group (56 cases) by computer. The conventional group was given routine general anesthesia, and the experimental group was given hourglass sign iliac fascial space block assisted anesthesia. The changes of basic physical signs during the perioperative period, postoperative analgesia and sedation, postoperative recovery, surgical stress, and anesthesia safety were compared between the two groups.Results Under different anesthesia regimens, the heart rate (HR) of the experimental group during tracheal intubation (T2), skin incision (T3), and postoperative (T4) were 78.24±10.33 times/min, 79.62±10.48 times/min, and 77.49±10.27 times/min, lower than the conventional group (83.11±10.61 times/min, 84.25±10.36 times/min, and 82.66±10.43 times/min) (P<0.05). The Mean Arterial Pressure (MAP) values were 113.64±20.33 mmHg, 115.75±20.61 mmHg, and 112.45±20.32 mmHg, lower than the conventional group (125.77±20.61 mmHg, 130.45±20.72 mmHg, and 128.62±20.33 mmHg) (P<0.05). The Visual Analogue Scale (VAS) scores of the experimental group at 1 hour, 3 hours, and 5 hours postoperatively were 3.88±0.26 points, 3.23±0.45 points, and 2.62±0.31 points, lower than the conventional group (4.35±1.27 points, 3.79±0.82 points, and 3.22±0.85 points) (P<0.05). The Ramsay Sedation Scale (RSS) scores of the experimental group were 3.83±0.25 points, 3.55±0.46 points, and 3.16±0.39 points, higher than the conventional group (3.04±0.78 points, 2.52±0.36 points, and 1.83±0.85 points) (P<0.05). The eye opening time and postanesthesia care unit (PACU) retention time of the experimental group were 15.45±3.36 minutes and 20.44±5.16 minutes, slightly higher than the conventional group (14.29±3.31 minutes and 19.45±3.46 minutes) (P>0.05). The application time and hospitalization time of patient-controlled intravenous analgesia (PCIA) in the experimental group were 24.33±5.61 hours and 8.28±1.46 days, lower than the conventional group (27.62±5.39 hours and 10.36±2.72 days) (P<0.05). After surgery, the norepinephrine (NE) and cortisol (Cor) of the experimental group were 170.25±20.33 pg/mL and 233.45±20.76 ng/mL, lower than the conventional group (184.33±20.42 pg/mL and 248.75±20.61 ng/mL) (P<0.05). The incidence of anesthesia related side effects in the experimental group was 10.71% (6/56), slightly higher than the conventional group of 7.14% (4/56) (P>0.05).Conclusion The hourglass sign iliac fascial space block assisted with general anesthesia can stabilize the perioperative basic physical signs of elderly patients with diabetes foot, enhance the analgesic and sedative effects, and reduce the stress of surgery without affecting the recovery or increasing the anesthesia risk.