李武军 陈莉 贡桑名久

摘 要：目的 分析海拔4300米高原低氧条件下，局部股神经阻滞麻醉下大隐静脉曲张高位结扎、主干剥脱手术的麻醉效果。方法 选择西藏阿里地区人民医院2016年1月～2017年12月收治的成人大隐静脉曲张患者62例，腹股沟区注射罗哌卡因局部麻醉并阻滞股神经，腹股沟及内踝处分别结扎大隐静脉并剥脱主干，观察手术时间及治疗效果。结果 所有患者手术顺利，治疗效果满意，平均手术时间（45.01±13.12）min，术后即可饮食，术后第1天下床活动，未发生伤口红肿、渗出及深静脉血栓等并发症，平均术后（3.20±0.51）d出院，均治愈。结论 罗哌卡因局部股神经阻滞麻醉下大隐静脉曲张高位结扎加主干剥脱治疗静脉曲张，麻醉及手术操作简单、安全性高、创伤小、恢复快，效果确切等，值得应用。

关键词：神经阻滞；股神经；大隐静脉曲张

中图分类号：R614.4 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.17.059

文章编号：1006-1959（2018）17-183-02

Abstract：Objective To analyze the anesthetic effect of high saphenous vein variceal ligation and main exfoliation under local anesthesia with local femoral nerve block under altitude of 4300 meters.Methods 62 adult patients with saphenous varices were enrolled from January 2016 to December 2017 in the Ali District People's Hospital of Tibet.Local anesthesia with ropivacaine was injected into the inguinal region and the femoral nerve was blocked.The inguinal and medial malleolus were ligated.The vein was exfoliated and the main operation was observed to observe the operation time and treatment effect.Results All patients underwent successful operation and satisfactory treatment.The average operation time was（45.01±13.12）min.After the operation，the patient was able to get out of bed on the first day after operation.No complications such as redness，exudation and deep vein thrombosis occurred.The average postoperative（3.20±0.51）d was discharged and all were cured.Conclusion Ropivacaine with local femoral nerve block anesthesia with high saphenous vein variceal ligation and main exfoliation for varicose veins，anesthesia and surgical operation is simple，safe，low trauma，quick recovery，exact effect，etc.，worthy of application.

Key words：Nerve block；Femoral nerve；Saphenous vein varicose

高原地區人体负荷较重，从事站立工作或重负荷劳动可以使下肢血管变直，同时肌肉的挤压作用减小，下肢血液回流减慢，下肢静脉内压力增高，引起下肢静脉曲张。未及时治疗，严重者可导致浅静脉血栓或曲张静脉破裂出血[1]，严重影响患者的生活质量。上世纪以来，大隐静脉高位结扎剥脱术一直是治疗大隐静脉曲张的经典手术方式，一般情况在椎管麻醉下进行。王明等[2]提出，应用局部阻滞麻醉股神经可达到与椎管内麻醉相同的效果。本研究选择西藏阿里地区人民医院2016年1月～2017年12月收治的大隐静脉曲张患者62例，行罗哌卡因局部麻醉并股神经阻滞下大隐静脉高位结扎剥脱术，现报告如下。……