腰丛-坐骨神经联合阻滞用于老年患者股骨上段骨折手术的效果探讨

Effect of lumbar plexus joint sciatic nerve block for femoral fractures surgery in elderly patients

目的探讨腰丛-坐骨神经联合阻滞用于老年患者股骨上段骨折手术的效果。方法选择80例老年股骨上段骨折患者,按入院顺序随机平均分为两组各40例,研究组患者使用腰丛-坐骨神经联合阻滞进行术前麻醉,对照组患者使用硬膜外术前麻醉。比较两组患者麻醉前后血压及心率变化情况及感觉、运动神经阻滞情况。结果研究组患者收缩压(SBP)、舒张压(DBP)及心率(HR)在麻醉前后变化不明显(P>0.05),而对照组SBP、DBP在麻醉后明显降低,差异具有统计学意义(P<0.05),且明显低于研究组;两组患者感觉、运动神经阻滞起效时间及感觉阻滞达最高层面所用时间比较,差异无统计学意义(P>0.05),研究组感觉神经阻滞持续时间(448.4±112.3 min)明显长于对照组(224.5±102.4 min),且其运动阻滞维持时间(197.4±70.2 min)明显低于对照组(254.6±90.6 min),差异具有统计学意义(P<0.05)。结论腰丛-坐骨神经联合阻滞对老年患者股骨上段骨折手术麻醉效果显著,安全可靠,值得临床推广应用。

Objective To investigate the effect of lumbar plexus joint sciatic nerve block for femoral fractures surgery in elderly pa-tients. Methods 80 cases of elderly patients with fractures of the upper femur in our hospital were randomly divided into two groups of 40 cases according to the order of admission patients. The study group patients received lumbar plexus joint sciatic nerve block for anesthesia preoperative while the control group received epidural anesthesia. The blood pressure,heart rate changes and sensory and motor nerve block situation were compared between the two groups of patients before and after anesthesia. Results The study group patients′SBP,DBP and HR did not change significantly before and after anesthesia（ P ﹥0. 05）,while the control group′s SBP,DBP decreased after anesthesia. The difference was statistically significant（ P 〈0. 05）,and which was significantly lower than study group. The two groups of patients′feeling,motor nerve block onset time and reached the highest level of sensory block time was not statistically significant difference（ P ﹥0. 05）. The study group′s duration of sensory block was（448. 4 ± 112. 3 ）min,which was significantly longer than the control group′s （224. 5 ± 102. 4）min. Its motor nerve block duration was（197. 4 ± 70. 2）min,which was significantly lower than the control group′s （254. 6 ± 90. 6）min. The difference was statistically significant（ P 〈0. 05）. Conclusion The lumbar plexus joint sciatic nerve block anesthesia has a remarkable effect,safe and reliable on upper femoral fractures in elderly patients which is worthy of clinical application.