超声引导下腰丛联合骶旁坐骨神经阻滞在高龄股骨颈骨折内固定术中的应用

Application of ultrasound-guided combined lumbar plexus and sacral sciatic nerve block in internal fixation of femoral neck fracture

目的探讨超声引导下腰丛联合骶旁坐骨神经阻滞在高龄患者股骨颈骨折内固定术中的应用效果。方法选取2015年1月~2016年3月在解放军空军第四五七医院接受内固定术的高龄股骨颈骨折患者80例为研究对象,并根据麻醉方式将其分为对照组和观察组各40例。对照组男性18例,女性22例;年龄75~92岁,平均85.67岁;使用传统的神经刺激仪引导行后路腰丛联合坐骨神经联合阻滞麻醉。观察组男性19例,女性21例;年龄76~93岁,平均85.72岁;使用超声引导下腰丛联合骶旁坐骨神经阻滞麻醉。观察两组患者围手术期心肺功能指标、认知功能(定向力、瞬时记忆和注意力计算力等)和术后疼痛的差异。结果麻醉穿刺前,对照组和观察组的平均动脉压(MAP)和心率(HR)分别为(92.32±10.42)、(92.35±11.27)mm Hg和(67.53±6.87)、(67.45±1.25)次/min,差异无统计学意义(P>0.05);麻醉完成后10min、手术开始时和手术结束时,观察组的MAP分别为(91.03±7.85)、(88.67±8.93)、(85.45±8.12)mmHg,显著高于对照组的(86.75±8.32)、(84.01±7.65)、(80.14±7.54)mm Hg,差异有统计学意义(P<0.05);上述时段观察组的HR分别为(67.92±1.89)、(68.12±1.34)、(66.97±1.26)次/min,显著高于对照组的(63.25±1.69)、(60.42±1.25)、(60.48±1.89)次/min,差异有统计学意义(P<0.05)。两组患者术前定向力、瞬时记忆和注意力计算力等认知功能指标无明显差异,术后两组患者上述指标较术前降低,而两组间术后比较无明显差异;术后观察组视觉模拟评分明显低于对照组,差异具有统计学意义(P<0.05)。结论超声引导下腰丛联合骶旁坐骨神经阻滞应用于股骨颈骨折手术,对患者的心肺功能无明显影响,且麻醉效果好,可明显减轻患者术后疼痛,有利于患者术后快速康复。

Objective To investigate the effect of ultrasound-guided combined lumbar plexus and sacral sciatic nerve block in internal fixation of femoral neck fracture. Methods Eighty elderly patients with femoral neck fracture treated in No. 457 Air Force Hospital of PLA from Jan. 2015 to Mar. 2016 were selected for the study, and were randomly divided into the control group and the observation group. The control group consisted of 40 patients, including 18 males and 22 females aged 75-92 years （mean ,85.67 years）. The posterior lumbar plexus combined with sciatic nerve block anesthesia was guided by the traditional nerve stimulator. There were 40 cases in the observation group, including 19 males and 21 females aged 76-93 years, with an average age of 85. 72 years. The observation group was treated with uhrasound-guided plexus combined with sacral sciatic nerve block. The differences of cardiopulmonary function, cognitive function （ directional force,instantaneous memory and attention calculation ability） and postoperative pain between the two groups were observed. Results The mean arterial pressure （MAP） before anesthesia puncture in the control group and the observation group was （92. 32 ± 10.42） mmHg and （ 92. 35 ± 11.27 ） mmHg, without statistical difference between the two groups. The heart rate （HR） before anesthesia puncture in the control group and the observation group was （ 67. 53 ± 6. 87 ） times/rain and （ 67.45 ± 1.25 ） times/ min,without statistical difference between the two groups. The MAP at 10 min after anesthesia, at operation and after operation in the observation group was （91.03 ± 7.85 ） mmHg, （ 88.67 ± 8.93 ） mmHg, （ 85.45 ± 8. 12 ） mmHg, respectively ,which were significantly higher than those of the control group （ 86.75 ± 8.32 ） mmHg, （84.01 ± 7.65 ） mmHg, （80. 14 ± 7.54 ） mmHg, respectively）, and the differences were statistically significant （ P 〈 0. 05 ）. The HR at 10 miu after anesthesia, at operation and after operation in the observation group was （67. 92 ± 1.89） times/min, （68. 12 ± 1.34） times/min, （ 66. 97 ± 1.26） times/min, respectively, which were significantly higher than those of the control group （ （63.25 ± 1.69 ） times/min, （60. 42 ± 1.25 ） times/rain, （60. 48 ± 1.89 ） times/min）, and the differences were statistically significant （P 〈 0. 05 ）. There was no remarkable difference in the cognitive function index such as directional force, instantaneous memory and attention between the two groups, which were lower than those before operation. The visual analogue score （VAS） of the observation group at 2 h after operation was （3. 11 ± 0. 75） points, which was lower than that of the control group （ 4. 02 ± 1.11 ） points,P 〉 0. 05）. Conclusion Ultrasound-guided combined lumbar plexus and sacral sciatic nerve block in treating femoral neck fracture has no remarkable effect on the heart and lung function,has good anesthetic effect,and can significantly reduce postoperative pain.