老年下肢骨折手术行超声介导的坐骨神经联合股神经阻滞麻醉的疗效评价

Efficacy of ultrasound-mediated sciatic and femoral nerve block anesthesia in elderly patients with lower extremity fractures

目的评价超声介导坐骨神经联合股神经阻滞麻醉在老年性下肢骨折中手术应用中的临床疗效。方法选取2015年6月至2017年1月34例入住遵义医学院第五附属(珠海)医院的单侧膝关节及膝关节以下骨折的患者34例,男性21例,女性13例,年龄68~83岁,平均年龄(74.08±7.70)岁。行坐骨神经联合股神经阻滞麻醉,记录麻醉操作、起效及持续时间,以视觉疼痛模拟评分(VAS)及生命体征变化进行效果评价,并记录术后进食时间及术后不良反应情况。不同时间节点心率、收缩压、舒张压及血氧饱和度的比较采用重复测量的单因素方差分析,采用t检验比较不同时间点VAS评分的差异。结果坐骨神经和股神经阻滞操作时间分别为(6.0±1.2)min、(1.5±1.4)min;起效时间分别为(15.0±6.2)min、(7.1±6.2)min;维持时间为(16.0±7.2)h、(7.0±5.2)h。神经阻滞效果Ⅰ级31例(91.17%,31/34),Ⅱ级3例(8.83%,3/34)。手术开始前VAS评分为(2.1±1.2)分,手术开始后30 min时VAS评分为(1.9±0.6)分,术毕VAS评分(1.8±0.7)分,手术开始前与术中及术毕比较差异无统计学意义(P>0.05);心率、收缩压、舒张压、血氧饱和度在T0、T1、T2、T3、T4、T5各时间点的差异不具有统计学意义(P>0.05)。患者术后不良反应少,对症处理后均得到明显缓解。结论超声介导下联合神经阻滞麻醉可为单侧下肢骨折手术患者提供满意的麻醉镇痛效果,且对生命体征干扰性小,术后并发症少。

Objective To evaluate the clinical efficacy of ultrasound-guided sciatic and femoral nerve block anesthesia in the treatment of elderly patients with lower extremity fractures. Methods Thirty-four elderly patients with fractures of unilateral knee or below the knee were included in this study. There were 21 men and 13 women, and they ranged in age from 68 to 83 years old, with an average age of（74.08±7.70）. All the patients underwent sciatic and femoral nerve block anesthesia. The anesthesia operation, onset, and duration were recorded. The visual acuity was simulated and the changes of vital signs were evaluated. The intensity of preoperative, intraoperative, and postoperative pain was also evaluated using the visual analogue scale（VAS）. Blood pressure, blood oxygen saturation before and after anesthesia at different time points, time to food intake, and postoperative complications were recorded. Heart rate, systolic blood pressure, diastolic blood pressure, and blood oxygen saturation at different time points were compared using one-way repeated measures analysis of variance. The VAS score was compared using the t-test. Results The operation time for sciatic nerve block and femoral nerve block was（6.0±1.2） min and（1.5±1.4） min, respectively; the onset time was（15.0±6.2） min and（7.1±6.2） min, and the duration time was（16.0±7.2） h and（7.0±5.2） h, respectively. The VAS scores before surgery, at 30 minutes after the beginning of surgery, and after surgery were（2.1±1.2）,（1.9±0.6）, and（1.8±0.7）, respectively, and there was no statistical difference between them. Heart rate, systolic blood pressure, diastolic blood pressure, and blood oxygen saturation at different time points did not differ significantly（P〉0.05）. Grade Ⅰ nerve block effect was achieved in 31（91.17%） cases, and grade Ⅱ was achieved in three（8.83%） cases. The adverse reaction of the patients after operation were less, and the symptoms were obviously alleviated after treatment. Conclusion Ultrasound-mediated sciatic and femoral nerve block can provide satisfactory anesthetic effect for patients with unilateral lower limb fractures, with less disturbance to vital signs and fewer postoperative complications.