腰丛+坐骨神经阻滞麻醉对口服阿司匹林股骨转子间骨折老年患者的效果观察

Lumbar plexus plus sciatic nerve block anesthesia in combination with oral aspirin for elderly patients with intertrochanteric fractures

目的探讨腰丛+坐骨神经阻滞麻醉在口服阿司匹林股骨转子间骨折老年患者中的应用效果。方法拟行手术治疗的股骨转子间骨折老年患者60例,分为实验组(术前口服阿司匹林)和对照组(术前无服用阿司匹林),每组各30例。实验组患者采用腰丛+坐骨神经阻滞麻醉,对照组患者采用腰麻-硬膜外联合麻醉。两组患者术后48h内均给予帕瑞昔布钠针40mg静脉注射和盐酸布桂嗪针0.1g肌肉注射,1次/12h。记录两组患者围麻醉期血压和心率的变化,及术后静息状态下视觉模拟疼痛评分和恶心、呕吐等麻醉不良反应的发生率。结果实验组患者围麻醉期血压、心率较对照组更平稳,术后疼痛评分与对照组比较均无统计学差异(均P>0.05);实验组术后不良反应发生率较对照组明显降低(P<0.05)。结论腰丛+坐骨神经阻滞麻醉对口服阿司匹林股骨转子间骨折的老年患者安全、有效,联合术后定时镇痛,可改善患者术后疼痛并降低术后麻醉不良反应发生率。

Objective To investigate the effect of lumbar plexus plus Ssciatic nerve block anesthesia in combination with oral aspirin for elderly patients with intertrochanteric fractures. Methods Sixty patients with intertrochanteric fractures were di- vided into aspilin group （n=30） and control group （n=30）. Patients in aspirin group were given aspirin preoperatively and received lumbar plexus plus sciatic nerve block anesthesia, while patients in control group received epidural anesthesia only, Routine in- travenous injection of parecoxib sodium 40mg and intramuscular injection bucinnazine hydrochloride 0. lg q12h were given after 48 h of operation in both groups. During the perianesthetic period changes in blood pressure and heart rate were recorded, also postoperatively during the resting period visual analog pain scores and adverse reactions to anesthesia were recorded. Results Patients in test group showed more stable blood pressure and heart rate compared to control group; the incidence of adverse re- actions in test group was significantly lower than that in control group （P〈0.05）. There was no significant difference in postoperative VAS scores between two groups （P 〉0.05）. Conclusion Lumbar plexus plus sciatic nerve block anesthesia in combination with oral aspirin and postoperative pain management can significantly relief postoperative pain and result in lower incidence of adverse reaction to anesthesia in elderly patients with intratrochanteric fractures.