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Received:October 19, 2024 Published Online:June 20, 2025
Received:October 19, 2024 Published Online:June 20, 2025
中文摘要: 目的 探讨腰交感神经节阻滞（LSGB）能否减轻下肢骨科手术止血带诱发的高血压反应。方法 随机选取2022年3月至2023年8月南京市第一医院择期进行骨科下肢手术，术中需要使用气动止血带的患者60例，且符合年龄18~70岁，美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级，止血带使用时间1~2.5 h，手术时间60~150 min。采用随机数字表法将入选者分为对照组（C组）30例和LSGB组（L组）30例。L组入室前行超声引导下LSGB，C组不做任何处理。入室后两组接受同质化的全身麻醉方案及管理。记录并比较两组患者以下围术期情况：（1）“止血带引起的高血压”（TH）发生率；（2）10个时点的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和心率（HR），包括患者入手术室前（T0），镇静后（基线，T1），止血带充气后的15 min（T2）、30 min（T3）、45 min（T4）、60 min（T5）、75 min（T6）和90 min（T7），以及止血带放气后即刻（T8）和5 min（T9）；（3）麻醉药物、血管活性药物及抗心律失常药物的用量；（4）拔管时间以及复苏室（PACU）停留时间；（5）15 项康复质量（QoR~15）量表评分。结果 与C组相比，L组TH发生率更低（20.00% vs 43.33%，χ2=5.04，P=0.03），瑞芬太尼、舒芬太尼、尼卡地平及艾司洛尔使用量减少，气管拔管时间和PACU停留时间缩短，差异有统计学意义（P<0.05）。与C组相比，L组SBP在T3~7 时较低，在T8~9时较高；DBP在T5~7时较低，在T2、T8 时较高；MAP在T5~7时较低，在T8 时较高；HR在T5~7 时较低；差异均有统计学意义（P<0.05）。结论 LSGB可降低下肢骨科手术患者TH的发生率，减少阿片类药物、血管活性药物及抗心律失常药物的使用，提供更稳定的血流动力学。
Abstract:Objective To investigate whether lumbar sympathetic ganglion block（LSGB）can alleviate the hypertensive response induced by tourniquets in lower extremity orthopedic surgery. Methods A total of 60 patients who needed pneumatic tourniquet during elective lower extremity orthopedic surgery in Nanjing First Hospital from March 2022 toAugust 2023 were randomly selected, and they met the age of 18?70 years, ASA grade I-II, with tourniquet using time of1?2.5 h and the operation time of 60?150 min. The randomized number table method was used to divide the participants into control group（group C, 30 cases）and LSGB group（group L, 30 cases）. Before entering the operation room, the ultrasound-guided LSGB was performed in group L , while no treatment was carried out in group C. After entering the operation room, the two groups received a homogeneous general anesthesia plan and management. The following perioperative conditions were recorded and compared between the two groups：（1）the incidence of“tourniquet?induced hypertension”（TH）；（2）systolic blood pressure（SBP）, diastolic blood pressure（DBP）, mean arterial pressure（MAP）and heart rate（HR）at 10 time points, including before entering the operating room（T0）, after sedation（baseline, T1）, 15 min（T2）, 30 min（T3）, 45 min（T4）, 60 min（T5）, 75 min（T6）and 90 min（T7）after tourniquet inflation, as well as immediate point（T8）and 5 min after tourniquet deflation（T9）；（3）the dosage of anesthetic drugs, vasoactive drugs and anti- arrhythmic drugs；（4）tracheal extubation time and stay in the post- anaesthesia care unit（PACU）；（5）15-item quality of rehabilitation（QoR-15）scale scores. Results Compared with group C, the incidence of TH in group L was lower（20.00% vs 43.33%, χ2=5.04, P=0.03）, the usages of remifentanil, sufentanil, nicardipine, and esmolol decreased, and the extubation time and PACU stay shortened, with statistically significant differences（P<0.05）. Compared with group C, in group L, SBP was lower at T3-7 and higher at T8-9；DBP was lower at T5-7 and higher atT2, T8；MAP was lower at T5-7 and higher at T8；HR was lower at T5-7, and the differences were statistically significant（P<0.05）. Conclusion LSGB can reduce the incidence of TH in lower extremity orthopedic surgery, reduce the use ofopioids, vasoactive drugs and anti?arrhythmic drugs, and provide more stable hemodynamics.
keywords: Lower extremity surgery Lumbar sympathetic ganglion Nerve block Tourniquets Hypertension Anesthetic drug Vasoactive drug
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