喉罩通气全麻用于老年股骨颈骨折内固定术中的镇痛效果研究

Study on analgesic effects of general anesthesia of laryngeal mask airway in senile femoral neck fracture with internal fixation

目的探究喉罩通气全麻与腰硬联合麻醉用于老年股骨颈骨折内固定术中的镇痛效果。方法选择2015年1月~2018年5月于武汉大学人民医院行股骨颈骨折内固定术的老年患者80例,采用随机数字表法分为对照组和观察组,每组各40例,对照组行腰硬联合麻醉,观察组行喉罩通气全身麻醉。采用视觉模拟评分(VAS)法评价两组术前、术后6 h疼痛情况,测定麻醉前、麻醉后5 min、内固定时及术毕两组患者心率(HR)、血氧饱和度(SpO2)及平均动脉压(MAP)水平,观察两组麻醉效果及并发症发生情况。结果两组麻醉前VAS评分比较,差异无统计学意义(P>0.05);两组麻醉6 h后VAS评分均降低,且观察组低于对照组,差异有统计学意义(P<0.05);两组麻醉前HR、SpO2、MAP水平差异无统计学意义(P>0.05);观察组麻醉后5 min HR、MAP水平较本组麻醉前降低,随后逐渐恢复至麻醉前水平;两组麻醉后5 min、内固定时及术毕HR、MAP水平比较,差异有统计学意义(P<0.05);观察组麻醉总优良率高于对照组,并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论喉罩通气全麻在老年股骨颈骨折内固定术中的应用效果优于腰硬联合麻醉,患者术中生命体征平稳,镇痛效果较好,并发症发生率低,值得临床推广应用。

Objective To investigate the analgesic effects of general anesthesia of laryngeal mask airway and combined spinal-epidural anesthesia (CSEA) in senile femoral neck fracture with internal fixation. Methods A total of 80 senile femoral neck fracture patients with internal fixation in the hospital from January 2015 to May 2018 were selected, and they were divided into control group and observation group by random number table method, with 40 cases in each group. Control group was given CSEA, while observation group was given general anesthesia of laryngeal mask airway. The preoperative and postoperative 6 h pain of two groups were evaluated by visual analogue scale (VAS);the heart rate (HR), oxygen saturation (SpO2), mean arterial pressure (MAP) of two groups before anesthesia, after anesthesia for 5 min, during internal fixation, after operation were detected. The anesthetic effects and adverse complications in the two groups were observed. Results There was no statistical difference in the VAS score between the two groups before anesthesia (P > 0.05). After anesthesia for 6 h, the VAS score of the two groups decreded, and the VAS score of the observation group was lower than that of control group (P<0.05). There was no statistical difference in the HR, SpO2, MAP levels between the two groups before anesthesia (P > 0.05). After anesthesia for 5 min, the HR and MAP of the observation group decreased compared with those before anesthesia, and they gradually recovered to the level before anesthesia. There was statistical difference in the HR and MAP levels after anesthesia for 5 min, during internal fixation, after operation (P<0.05). The total excellent and good rate of anesthesia in the observation group was higher than that in the control group, and the total incidence of complications was lower than that in the control group, with statistically significant differences (P<0.05). Conclusion The effect of general anesthesia of laryngeal mask airway in senile femoral neck fracture with internal fixation is better than that of CSEA, it can achieve stable vital signs, good analgesic effects and low incidence of complications, which is worthy of clinical promotion and application.