右美托咪定复合腰骶丛阻滞在老年患者股骨近端防旋髓内钉内固定术中的应用

The application of dexmedetomidine combined with lumbosacral plexus block in senile intertrochanteric fractures treated with proximal femoral nail anfirotation

目的比较右美托咪定复合超声引导下腰骶丛阻滞或硬膜外腔阻滞用于老年患者股骨近端防旋髓内钉（proximal femoral nail antirotation，PFNA）内固定术的效果。方法选择股骨粗隆间骨折择期行PFNA内固定术的老年患者60例，美国麻醉医师协会（ASA）分级Ⅱ或Ⅲ级，年龄65岁-75岁，按随机数字表法分为2组，硬膜外腔阻滞组（E组）和腰骶丛阻滞组（L组），每组30例。E组经k～k间隙行硬膜外穿刺，局部麻醉药为0．5％罗哌卡因10ml-15ml；L组在超声引导下L2—L3间隙旁腰丛阻滞及骶丛阻滞，各注射0．5％罗哌卡因12ml。15min后两组患者均经静脉泵入右美托咪定，负荷剂量0．8ug／kg，维持泵速1．0ug·kg-1·h-1。术中若出现疼痛不适，予静脉注射芬太尼20ug/次。比较两组患者麻醉手术过程中的平均动脉压、心率、芬太尼用量、麻黄碱用量、术中输液量及副作用情况，记录术后随访患者的感觉、运动阻滞维持时间。结果阻滞15min后，两组患者阻滞效果相似。L组感觉阻滞维持时间及运动阻滞维持时间明显长于E组（P〈0．05），同时L组感觉阻滞维持时间明显长于运动阻滞维持时间（P〈0．05）。与L组比较，E组血压明显降低，心率明显增快（P〈0．05）；E组输液量[（1360±240）ml]明显多于L组[（865±180）ml]（P〈0．05）。结论右美托咪定辅助超声引导下腰骶丛神经阻滞用于老年患者PFNA内固定术效果良好，血流动力学平稳，副作用少，较硬膜外阻滞具有更大的优势。

Objective To compare the effects of intravenous dexmedetomidine combined with ultrasound guided lumbosacral plexus block and epidural block in intertrochanteric femoral fracture treated with proximal femoral nail antirotation （PFNA） in elderly patients. Methods Sixty patients of ASA Ⅰ - Ⅱ, aged 65 y-75 y, suffering from intertrochanteric femoral fracture and undergoing elective PFNA fixation, were included in this study and randomly divided into 2 groups （n=30）： lumbosacral plexus block group （group L） and epidural block group （group E ）. Catheter was inserted into epidural space at L3-L4 interspaces and a total volume of 10 ml-15 ml of 0.5% ropivacaine was injected into epidural space in group E. Patients in group L received ultrasound-guided lumbar and sacral plexus block with 0.5% ropivacaine. Fifteen min after block, a loading dose of dexmedetomidine 0.8 ug/kg was infused over 15 min, with a continuous dose of 1 ug·kg· h-1. Twenty p,g fentanyl was given per time intravenous if any pain was felt. The mean arterial pressure, heart rate, the consumption of fentanyl and ephedrine, the volume of fluid resuscitation and the incidence of adverse reactions were recorded. Results Fifteen rain after blockage, the block effect were similar between the two groups. The duration of sensor and motor block of group L were significantly longer than those of group E （P〈0.05）. And in group L, the duration of sensor block was longer than that of motor block （P〈0.05）. The MAP was significantly attenuated in the group E （P〈0.05）. Patients in group L [ （865±180） ml ]received less fluid than those in the group E [ （1 360±240） ml ] （P〈0.05）. Conclusions The application of intravenous dexmedetomidine combined with ultrasound-guided lumbosacral plexus block provides good effects in intertroehanterie femoral fracture treated with proximal femoral nail antirotation. There is an advantage over epidural anesthesia.