摘要
目的:分析超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞在老年髋部骨折患者麻醉镇痛中的应用价值。方法:选取老年髋部骨折患者80例,按入院顺序编号,根据单双号法分为全麻组(全凭静脉麻醉组)和联合阻滞组(全凭静脉麻醉+超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞),各40例。记录术中麻醉药物用量、术后24 h静脉自控镇痛(PCIA)用药量及麻醉苏醒时间。比较两组在入室时(T0)、插管(T1)、手术开始5 min(T2)、手术结束时(T3)的心率(HR)及平均动脉压(MAP)。比较两组拔管30 min和出恢复室时的Ramsay镇静评分。比较两组术后3、6、12、24 h静息时视觉模拟量表(VAS)评分。比较术前及术后24、48、72 h简易智力状态检查量表(MMSE)评分及认知障碍发生率。记录两组不良反应发生情况。结果:联合阻滞组麻醉药物(舒芬太尼、丙泊酚)用量和术后24 h静脉自控镇痛用药量低于全麻组,麻醉苏醒时间短于全麻组(均P<0.05)。HR及MAP组间、时间及交互比较差异有统计学意义(均P<0.05)。联合阻滞组在T2、T3时HR和MAP高于全麻组(均P<0.05)。拔管30 min时,联合阻滞组Ramsay镇静评分显著低于全麻组(P<0.05)。出恢复室时,两组间Ramsay镇静评分比较差异无统计学意义(P>0.05)。VAS评分组间、时间及交互比较差异有统计学意义(均P<0.05)。联合阻滞组在术后3、6、12 h时VAS评分显著低于全麻组(均P<0.05)。两组MMSE评分随术后时间延长,呈先下降后升高趋势,且联合阻滞组术后各时间点显著高于全麻组(均P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论:超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞应用于老年髋部骨折患者镇痛效果好,能有效减少麻醉药物用量,对认知功能损伤小。
Objective:To analyze the application value of ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block in the anesthesia and analgesia of elderly patients with hip fractures.Methods:Eighty elderly patients with hip fractures were selected and numbered according to the order of admission,and then they were randomly divided into general anesthesia group(total intravenous anesthesia group)and combined block group(total intravenous anesthesia plus ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block)by single-double number method,with 40 cases in each group.The consumption of intraoperative anesthetic drugs,dosage of patient-controlled intravenous analgesia(PCIA)within 24 hours after surgery and recovery time from anesthesia were recorded.The HR and MAP were compared between two groups at the time of entering the operating room(T 0),the time of intubation(T 1),5 minutes after the beginning of the surgery(T 2)and the end of the surgery(T 3).Ramsay scores were compared between the two groups at 30 minutes after extubation and when leaving the recovery room.The VAS scores at rest were compared between the two groups at 3,6,12 and 24 hours after operation.The MMSE score and the incidence of cognitive impairment were compared before operation and 24,48,72 hours after operation.The adverse reactions of the two groups were recorded.Results:Compared with the general anesthesia group,the consumption of sufentanil and propofol and the dosage of patient-controlled intravenous analgesia within 24 hours after operation in the combined block group were lower,and the recovery time from anesthesia was shorter(all P<0.05).There were significant differences in HR and MAP between groups,time and interaction(all P<0.05).HR and MAP in the combined block group were higher than those in the general anesthesia group at T 2 and T 3(all P<0.05).At 30 minutes after extubation,Ramsay score in the combined block group was significantly lower than that in general anesthesia group(P<0.05).There was no significant difference in Ramsay score between the two groups at the time of leaving the recovery room(P>0.05).There were statistically significant differences in VAS scores between groups,time and interaction(all P<0.05).The VAS scores at 3,6 and 12 hours after operation in the combined block group were significantly lower than those in the general anesthesia group(all P<0.05).The MMSE scores of the two groups decreased first and then increased with the extension of postoperative time,and the MMSE scores of the combined block group were significantly higher than those of the general anesthesia group at each time point after operation(all P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block has a good analgesic effect in elderly patients with hip fracture,which can effectively reduce the dosage of anesthetic drugs and has little damage to cognitive function.
作者
何旭秀
韩娟
HE Xuxiu;HAN Juan(Department of Anesthesiology,Qinghai Provincial Hospital of Traditional Chinese Medicine,Xining 810099,China)
出处
《陕西医学杂志》
CAS
2023年第6期714-718,共5页
Shaanxi Medical Journal
基金
青海省卫生计生委科研课题(2018-WJZDX-61)。
关键词
髋部骨折
超声引导
高位髂筋膜间隙阻滞
骶丛阻滞
血流动力学
认知功能
Hip fractures
Ultrasonic guidance
High fascia iliaca compartment block
Sacral plexus block
Hemodynamics
Cognitive function
