髂筋膜腔阻滞联合喉罩在老年患者髋部骨折术中的临床应用

The clinical application of fascia compartment nerve block combined with laryngeal mask anesthesia in elderly patients undergoing fractured femur surgery

目的比较髂筋膜腔阻滞联合喉罩和气管插管全身麻醉在老年患者髋部骨折术中的应用效果。方法选取南京中医药大学附属医院2016年1月至2018年6月间行单侧髋部骨折防旋股骨近端髓内钉(PFNA)手术治疗的老年患者60例,随机分为观察组和对照组,每组30例。观察组术前30 min以0.25%罗哌卡因30 mL行髂筋膜腔阻滞,术中采用喉罩全身麻醉。对照组采用常规气管插管全身麻醉。记录2组麻醉前(T1)、术前摆放体位(T2)、PFNA植入扩髓(T3)、术毕(T4)和苏醒拔管时(T5)的平均动脉压(MAP)、心率(HR),术中舒芬太尼总量,术后拔管时间、清醒时间,Steward苏醒评分和术后视觉模拟疼痛评分(VAS)评分,以及患者恶心、呕吐等不良反应。结果观察组MAP与HR在T2、T3和T5时[(83.9±6.4)mm Hg、(100.6±10.1) mm Hg和(81.6±4.8) mm Hg,(69.5±3.2)次/min、(78.3±3.0)次/min和(71.3±2.6)次/min]明显低于对照组[(102.0±8.0) mm Hg、(110.5±13.7) mm Hg和(97.2±13.5) mm Hg,(84.8±2.9)次/min、(98.5±4.8)次/min和(86.0±3.2)次/min,P<0.05]。观察组术中舒芬太尼总用量显著低于对照组[(29.2±3.6)μg vs (41.7±3.8)μg,P<0.05],术后清醒拔管时间显著少于对照组[(10.9±1.8) min vs (19.6±3.2) min,P<0.05],术后Steward苏醒评分显著高于对照组[(5.4±0.5) vs (4.9±0.5),P<0.05],术后VAS评分显著低于对照组[(0.7±0.6) vs (3.3±0.8),P<0.05]。2组术后不良反应差异无统计学意义(P>0.05)。结论髂筋膜腔阻滞联合喉罩全身麻醉可以安全有效地用于老年患者髋部骨折术,较传统气管插管全身麻醉血流动力学更为平稳、苏醒迅速和镇痛优异。

Objective To compare the clinical effects of ultrasound-guided fascia iliaca compartment block(FICB)combined laryngeal mask(LMA)anesthesia and general anesthesia with intubation in elderly patients undergoing fractured femur surgery. Methods Sixty patients undergoing proximal femornal nail antirotion(PFNA)surgery were randomized into observation group(FICB with 30 mL of 0.25%ropivocaine combined with LMA)or control group(general anesthesia with intubation).The average of arterial pressure(MAP)and heart rate(HR)was measured at time points before anesthesia(T1),positioning patients(T2),enlarging the marrow cavity(T3),the end of surgery(T4)and extubation(T5).The total intravenous sulfentanyl consumption,the time of extubation and conscious recovery,Steward's Postoperative Recovery Scale and Visual Analog Scale(VAS)were recorded.Nausea and vomiting were observed in the recovery room. Results MAP and HR in the observation group[(83.9±6.4)mmHg,(100.6±10.1)mmHg and(81.6±4.8)mmHg,(69.5±3.2)/min,(78.3±3.0)/min and(71.3±2.6)/min]at T2,T3 and T5 were significantly lower than that in the control group[(102.0±8.0)mmHg,(110.5±13.7)mmHg and(97.2±13.5)mmHg,(84.8±2.9)/min,(98.5±4.8)/min and(86.0±3.2)/min,P<0.05].The total intravenous sulfentanyl consumption[(29.2±3.6)μg vs(41.7±3.8)μg],the time of extubation and consciousness recovery[(10.9±1.8)min vs(19.6±3.2)min],and VAS[(0.7±0.6)vs(3.3±0.8)]in the observation group were significantly lower than that in the control group(P<0.05).Steward's Postoperative Recovery Scale in the observation group was significantly higher than in the control group[(5.4±0.5)vs(4.9±0.5),P<0.05].There was no difference in nausea and vomiting between the two groups(P>0.05). Conclusion FICB with LMA could be benefit to reduce the pain and facilitate consciousness from general anesthesia in old patients.