超声引导下腰丛神经阻滞应用于高龄患者股骨转子间骨折手术的临床效果

Clinical effects of ultrasound-guided lumbar plexus block in elderly patients underwent femoral intertrochanteric fractures surgery

目的观察超声引导下腰丛神经阻滞应用于高龄患者股骨转子间骨折手术的临床效果。方法择期拟行单侧股骨转子间骨折手术的高龄患者60例，年龄71岁-98岁，体重52kg～70kg，美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级，按照随机数字表法分为超声引导下腰丛神经阻滞组（UNB组）和腰硬联合麻醉组（SEA组），每组30例。记录麻醉前（T0）及麻醉后10（T1）、30（T2）、60min（T3）时收缩压（systolicbloodpressure，SBP）、舒张压（diastolicbloodpressure，DBP）、心率（heartrate，HR），记录麻醉操作时间、起效时间、维持时间和手术时间及术中的出血量和输液量；评价麻醉效果，记录副作用的发生情况。结果SEA组T1、T2时SBP、DBP低于本组内R、L时和UNB组相应时点，而HR快于本组内R、L时和UNB组相应时点（P〈0．05）。两组麻醉操作时间、手术时间、术中出血量比较，差异无统计学意义（p〉0．05）；UNB组麻醉起效时间为（12．1±3．8）min，麻醉维持时间为（414±43）min，分别长于SEA组的（7．7±1．9）min和（192±23）min，差异有统计学意义（P〈0．05）；UNB组术中输液量（978±182）ml，明显少于SEA组（1360±297）ml，差异有统计学意义（P〈0．05）。两组麻醉效果优良率均为100％。SEA组术中有4例（13％）发生低血压，术后2例（7％）发生恶心呕吐，5例（17％）发生尿潴留，副作用发生率明显高于UNB组[术后仅1例（3％）发生恶心]（P〈0．05）。结论超声引导下腰丛神经阻滞应用于高龄患者股骨转子问骨折手术麻醉效果确切，血流动力学平稳，镇痛维持时间长，副作用发生率低。

Objective To investigate the clinical effects of ultrasound-guided lumbar plexus block in elderly patients underwent femoral intertrochanteric fractures surgery. Methods Sixty elderly patients with aged 71 y-98 y old, body weight 52 kg -70 kg, ASAⅡ～Ⅲ grade undergoing elective unilateral hip fracture surgery, were equally randomized into the ultrasound -guided lumbar nerve block group （group UNB ） and combined spinal epidural anesthesia group （group SEA ）. Systolic blood pressure（SBP）, diastolic blood pressure （DBP）, heart rate （HR） before anesthesia （T0）, at 10 （T1）, 30 （T2）, 60 min （T3） after anesthesia, anesthesia procedure time, establishment time, duration time, surgery time, bleeding and infusion volume during the operation were recorded. Anesthesia effects were evaluated. The incidence of adverse effects were recorded. Results SBP and DBP in group SEA at TI and T2 were lower than that at To and T3, and than that at T1 and T2 in group UNB, and HR were faster than that at To and T3, and than that at T1 and Tg in group UNB （P〈0.05）. Anesthesia procedure time, surgery time and bleeding volume in two groups were not different significantly（P〉0.05）. Anesthesia establishment time （12.1±3.8） min and duration time （414±43） rain in group UNB were longer than that （7.7±1.9） min and （192±23） min in group SEA（P〈0.05）. Infusion volume in group UNB[ （978±182） ml ] were less than that in group SEA [（1 360±297） ml]（P〈0.05）. The excellent and good rates of anesthesia effect in two groups were both 100%. There were 4 cases （13%） of hypotension in the operation, 5 cases （17%） of urinary retention and 2 cases （7%） of nausea and vomiting after the operation in group SEA, and the incidence rate of adverse reactions was obviously higher than that of group UNB （3%） （P〈0.05）. Conclusions Ultrasound-guided lumbar plexus block in elderly patients can provide satisfactory anesthesia for femoral intertrochanteric fractures surgery with stable hemodynamic, longer analgesia maintaining time, and lower incidence rate of adverse reactions, so it is an ideal anesthetic option.