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

Ultrasound Guided the Application of Low Back Plexus Combined with Parasacral Sciatic Nerve Block in Internal Fixation of Femoral Neck Fracture in Elderly Patients

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2018年2月-2019年2月于本院就诊的高龄股骨颈骨折患者122例,按照随机数字表法将其分为对照组和观察组,各61例。对照组在传统神经刺激仪引导下行后路腰丛联合坐骨神经阻滞麻醉,观察组在超声引导下行腰丛联合骶旁坐骨神经阻滞。比较两组的穿刺时间、平均动脉压(MAP)、心率(HR)变化情况、认知功能评分及VAS评分。结果:观察组穿刺时间明显短于对照组,差异有统计学意义(P<0.05)。麻醉穿刺前,两组患者MAP、HR比较,差异均无统计学意义(P>0.05);麻醉完成后10 min、手术开始时、手术结束后,观察组MAP、HR水平均优于对照组,差异均有统计学意义(P<0.05)。两组患者术后认知功能各指标评分及总评分比较,差异均无统计学意义(P>0.05)。术后2、12、24 h,观察组VAS评分均低于对照组,差异均有统计学意义(P<0.05)。结论:予以高龄股骨颈骨折内固定术患者超声引导下腰丛联合骶旁坐骨神经阻滞麻醉,效果理想,可推广应用。

Objective:To investigate the effect of ultrasound-guided low back plexus combined with Parasacral sciatic nerve block in internal fixation of femoral neck fracture in elderly patients.Method:A total of 122 elderly patients with femoral neck fractures treated in our hospital from February 2018 to February 2019 were selected and divided into control group and observation group,61 cases in each group.The control group was anesthetized with posterior lumbar plexus combined with sciatic nerve block guided by conventional nerve stimulator,and the observation group was treated with ultrasound guided lumbar plexus combined with parasacral sciatic nerve block.The puncture time,mean arterial pressure (MAP),heart rate (HR) change,cognitive function score,and VAS score were compared between the two groups.Result:The puncture time in the observation group was significantly shorter than that in the control group,the difference was statistically significant (P<0.05).Before anesthesia puncture,MAP and HR were compared between the two groups,the differences were not statistically significant (P>0.05).10 min after the completion of anesthesia,at the beginning of the operation and after the operation,the levels of MAP and HR in the observation group were better than those in the control group,the differences were statistically significant (P<0.05).Comparison of indexes and total scores of postoperative cognitive function between the two groups,the differences were not statistically significant (P>0.05).After surgery 2,12,24 hours,VAS score in the observation group were lower than those in the control group,the differences were statistically significant (P<0.05).Conclusion:Ultrasound guided low back plexus combined with parasacral sciatic nerve block anesthesia performed in elderly patients with internal fixation of femoral neck fracture,the effect is ideal,it can be popularized and applied.