Abstract:

Objective　To analyze the anesthetic effects of "bow tie sign" iliofascial multipoint block and single point block combined with upper popliteal sciatic nerve block in upper popliteal fossa during operation for elderly patients with diabetic feet. Methods　Ninety-five elderly patients undergoing DF operation in Tongchuan People's Hospital from April 2021 to February 2024 were divided into a control group (46 cases) and an observation group (49 cases) according to the anesthesia methods. In the control group, there were 29 males and 17 females; they were (70.15±3.96) years old; the duration of DM was (13.02±2.98) years; the duration of DF was (2.43±0.34) years; there were 23 cases of American Society of Anesthesiologists (ASA) grade Ⅰ and 23 cases of grade Ⅱ. In the observation group, there were 25 males and 24 females; they were (69.52±3.45) years old; the duration of DM was (12.42±2.74) years; the duration of DF was (2.30±0.31) years; there were 26 cases of ASA grade Ⅰ and 23 cases of grade Ⅱ. The control group took "bow tie sign" iliofascial single point block and sciatic nerve block in upper popliteal fossa. The observation group took "bow tie sign" iliofascial multipoint block and sciatic nerve block in upper popliteal fossa. The hemodynamic indicators and stress indicators before anesthesia (T₀), 10 min after anesthesia (T₁), and 20 min after operation (T₂), sensation and motor nerve block onset and maintenance times, pain degrees, comfort degrees, and incidence rates of adverse reactions were compared between the two groups. χ² test, t test, and analysis of variance were used for the statistical analysis. Results　At T₁ and T₂, the mean arterial pressures (MAP) [(84.25±3.69) mmHg (1 mmHg=0.133 kPa) vs. (75.41±2.69) mmHg and (85.26±3.89) mmHg vs. (79.41±3.08) mmHg, heart rates (HR) [(70.23±3.26) beats/min vs. (68.17±3.67) beats /min and (71.05±3.54) beats/min vs. (72.36±3.78) beats/min], and blood oxygen saturation (SpO₂) [(87.62±4.05)% vs. (84.19±4.59)% and (89.47±4.87)% vs. (82.05±4.99)%] in the observation group were better than those in the control group (all P<0.05). At T₁ and T₂, the levels of cortisol (Cor) [(280.36±26.74) μg/L vs. (295.16±25.74) μg/L and (272.20±24.96) μg/L vs. (286.78±25.11) μg/L], endothelin (ET) [(77.56±8.24) ng/L vs. (83.47±9.74) ng/L and (71.29±7.15) ng/L vs. (76.96±8.14) ng/L], and malondialdehyde (MDA) [(67.52±3.54) μmol/L vs. (72.96±4.05) μmol/L and (61.47±3.28) μmol/L vs. (64.89±3.84) μmol/L] in the observation group were better than those in the control group (all P<0.05). The motor and sensory nerve block maintenance times in the observation group were longer than those in the control group [(356.24±19.57) min vs. (286.95±17.25) min and (382.41±23.62) min vs. (327.18±21.05) min; both P<0.05]. Twelve hours after surgery, the pain score and score of Bruggman Comfort Scale (BCS) in the observation group were lower than those in the control group (2.63±0.41 vs. 3.89±0.64 and 1.85±0.32 vs. 2.63±0.38; both P<0.05). There was no statistical difference in the incidence rate of adverse reactions between the two groups (P>0.05). Conclusion　"Bow tie sign" iliofascial multipoint block combined with sciatic nerve block in upper popliteal fossa can effectively stabilize hemodynamics, reduce stress response, relieve postoperative pain, and do not increase adverse reactions in DF patients.

Key words: Multipoint block,  , Single point block,  , "Bow tie sign" iliac fascia,  , Sciatic nerve block in upper popliteal fossa,  , Diabetic foot surgery

摘要：

目的　分析“领结征”髂筋膜多点阻滞与单点阻滞联合腘窝上角坐骨神经阻滞在老年糖尿病足（diabetic foot，DF）患者术中的麻醉效果。方法　选取2021年4月至2024年2月铜川市人民医院收治的95例行DF手术治疗的老年患者为研究对象。按不同麻醉方法将其分为对照组46例和观察组49例。对照组男29例，女17例，年龄（70.15±3.96）岁，糖尿病病程（13.02±2.98）年，DF病程（2.43±0.34）年；美国麻醉医师协会（ASA）分级Ⅰ级、Ⅱ级各23例。观察组男25例，女24例，年龄（69.52±3.45）岁，糖尿病病程（12.42±2.74）年，DF病程（2.30±0.31）年；ASA分级Ⅰ级26例，Ⅱ级23例。对照组进行“领结征”髂筋膜单点阻滞联合腘窝上角坐骨神经阻滞，观察组进行“领结征”髂筋膜多点阻滞联合腘窝上角坐骨神经阻滞。比较两组麻醉前（T₀）、麻醉完成后10 min（T₁）、术后20 min（T₂）血流动力学指标、应激指标、感觉和运动神经阻滞起效和维持时间、疼痛程度、舒适程度及不良反应。采用χ²检验、t检验和方差分析进行统计分析。结果　T₁、T₂时，观察组平均动脉压（mean arterial pressure，MAP）［（84.25±3.69）mmHg（1 mmHg=0.133 kPa）比（75.41±2.69）mmHg、（85.26±3.89）mmHg比（79.41±3.08）mmHg、心率（heart rate，HR）［（70.23±3.26）次/min比（68.17±3.67）次/min、（71.05±3.54）次/min比（72.36±3.78）次/min］、血氧饱和度（blood oxygen saturation，SpO₂）［（87.62±4.05）%比（84.19±4.59）%、（89.47±4.87）%比（82.05±4.99）%］均优于对照组（均P<0.05）。T₁、T₂时，观察组皮质醇（cortisol，Cor）［（280.36±26.74）μg/L比（295.16±25.74）μg/L、（272.20±24.96）μg/L比（286.78±25.11）μg/L］、内皮素（endothelin，ET）［（77.56±8.24）ng/L比（83.47±9.74）ng/L、（71.29±7.15）ng/L比（76.96±8.14）ng/L］、丙二醛（malondialdehyde，MDA）［（67.52±3.54）μmol/L比（72.96±4.05）μmol/L、（61.47±3.28）μmol/L比（64.89±3.84）μmol/L］水平均优于对照组（均P<0.05）。观察组运动神经阻滞、感觉神经阻滞维持时间均长于对照组［（356.24±19.57）min比（286.95±17.25）min、（382.41±23.62）min比（327.18±21.05）min，均P<0.05］。术后12 h，观察组疼痛评分、舒适度状态量表（Bruggman Comfort Scale，BCS）评分均低于对照组［（2.63±0.41）分比（3.89±0.64）分、（1.85±0.32）分比（2.63±0.38）分，均P<0.05］。两组不良反应发生率差异无统计学意义（P>0.05）。结论　DF手术患者进行“领结征”髂筋膜多点阻滞联合腘窝上角坐骨神经阻滞可有效稳定其血流动力学，降低其应激反应，缓解其术后疼痛，不增加不良反应。

关键词: 多点阻滞, 单点阻滞, “领结征”髂筋膜, 腘窝上角坐骨神经阻滞, 糖尿病足手术