超声引导下腰丛复合坐骨神经阻滞麻醉对老年髋部骨折患者术后感染以及免疫功能的影响

Effect of ultrasound-guided lumbar plexus combined with sciatic nerve block anesthesia on postoperative infection and immune function in elderly patients with hip fracture

目的探讨超声引导下腰丛复合坐骨神经阻滞麻醉对老年髋部骨折患者术后感染以及免疫功能的影响。方法选取2017年12月至2018年12月本院收治的80例老年髋部骨折患者为研究对象,按照入院顺序分为观察组和对照组,每组40例。对照组实施常规蛛网膜下腔阻滞麻醉复合连续硬膜外麻醉,观察组实施超声引导下腰丛复合坐骨神经阻滞麻醉,对比两组患者术后感染、免疫功能及血流动力学变化情况。结果术前两组患者免疫球蛋白指标水平比较差异无统计学意义;术后6 h、24 h,观察组免疫球蛋白指标水平均高于对照组(P<0.05);观察组术后感染发生率低于对照组(P<0.05);观察组神经阻滞起效时间长于对照组,维持时间长于对照组(P<0.05);观察组术后不时间点视觉模拟评分(VAS)均低于对照组(P<0.05);观察组术后各时间点血浆S100β浓度均低于对照组(P<0.05)。结论老年髋部骨折患者实施超声引导下腰丛复合坐骨神经阻滞麻醉,可维持血流动力学稳定,提升免疫功能,降低术后感染,值得推广。

Objective To investigate the effect of ultrasound-guided lumbar plexus combined with sciatic nerve block anesthesia on postoperative infection and immune function in elderly patients with hip fracture.Methods 80 elderly patients with hip fractures were enrolled in our hospital from December 2017 to December 2018,which were divided into observation group and control group by the order of admission,with 40 cases in each group.The patients in the control group underwent conventional subarachnoid block anesthesia combined with continuous epidural anesthesia.The observation group underwent ultrasound-guided lumbar plexus combined with sciatic nerve block anesthesia.The postoperative infection,immune function and hemodynamic changes were compared between the two groups.Results There was no significant difference in the level of immunoglobulin between the two groups before operation.At 6 h and 24 h after operation,the level of immunoglobulin in the observation group was higher than that in the control group(P<0.05).The incidence of post-infection was lower than that of the control group(P<0.05).The onset time of the nerve block in the observation group was longer,the maintenance time was longer than that in the control group(P<0.05).The visual analog score(VAS) in the observation group of different time point were lower than the control group postoperative(P<0.05).Plasma S100β concentrations were lower in the observation group at each time point(P<0.05).Conclusion Ultrasound-guided lumbar plexus combined with sciatic nerve block anesthesia in elderly patients with hip fracture can maintain hemodynamic stability,enhance facial immune function and reduce postoperative infection,which is worthy of promotion.