连续腘窝上坐骨神经联合隐神经阻滞镇痛对足踝皮瓣移植后皮瓣成活和局部血运的影响

doi:10.3969/j.issn.2095-9400.2020.03.016

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摘要目的：探讨连续腘窝上坐骨神经联合隐神经阻滞镇痛对足踝皮瓣移植后皮瓣成活以及局部血运的影响。方法：选择2018年3月至2019年4月在宁波市第六医院择期行股外侧皮瓣移植足踝部皮肤软组织缺损的患者60例，美国麻醉医师协会（ASA）分级为I～II级，随机分为连续腘窝上坐骨神经联合隐神经阻滞镇痛组（S组）和静脉自控镇痛组（C组），每组30例。观察2组患者足踝部游离移植皮瓣后皮瓣的血液循环及皮瓣成活的变化，记录2组患者术后6 h、12 h、24 h、2 d、3 d各个时点VAS评分及不良反应发生情况。结果：S组患者毛细血管充盈时间评分、局部皮瓣弹性评分和皮瓣存活率均高于C组，血管危象率低于C组（P＜0.05），术后6 h、12 h 、24 h、2 d、3 d的VAS评分S组更低（P＜0.05）；S组不良反应发生率低于C组（P＜0.05）。结论：连续腘窝上坐骨神经联合隐神经阻滞镇痛可提高足踝皮瓣移植术患者皮瓣局部血运，提高皮瓣成活率。

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	王珏
	张益维
	王秀珍
	陈洁
	袁娜
	葛叶盈

关键词 ：坐骨神经, 隐神经, 术后镇痛, 游离皮瓣移植术, 成活率

Abstract：Objective: To evaluate the effects of continuous popliteal sciatic nerve combined with saphenous nerve block on the local blood supply and survival of circulation skin flap in patients after free flap transplantation for the foot and ankle. Methods: A prospective study was made on 60 patients with ASA I-II who underwent anterolateral thigh flap transplantation for skin and soft tissue defects of the feet and ankles treated in Ningbo NO.6 Hospital from March 2018 to April 2019. All the patients were randomly assigned to receive either continuous popliteal sciatic nerve combined saphenous nerve block (S group) or controlled intravenous analgesia (C group), with 30 cases in each group. The blood circulation and survival of free flap were compared between two groups, VAS score was recorded at 6 h, 12 h, 24 h, 2 d, 3 d after operation, and adverse reactions occur were analyzed. Results: The scores of flap elasticity, capillary refill time and flap survival rate in S group were higher than those in the C group. The incidence of vascular crisis in the S group was lower than that in the C group, with statistical difference (P<0.05). VAS of 6 h, 12 h, 24 h, 2 d, 3 d and the incidence of adverse reactions after operation in S group were lower than the C group. Conclusion: Continuous popliteal sciatic nerve combined saphenous nerve block could improve the local flap of patients with free flap transplantation for the foot and ankle, and improve the survival rate of flap.

Key words： popliteal sciatic nerve saphenous nerve postoperative analgesia free flap transplantation survival rate

基金资助:浙江省医药卫生科技计划项目（2017KY141）；宁波市鄞州区农业与社会发展科技项目（2017-18）。

通讯作者: 葛叶盈，主任医师，硕士生导师，Email：geyeying 59198@163.com。

作者简介: 王珏（1984-），女，浙江台州人，主治医师。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.03.016 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I3/245

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