B超引导下神经阻滞麻醉对股骨粗隆间骨折患者的麻醉效果及对血清ICAM-1水平的影响

Anesthesia Effect of Nerve Block Anesthesia under B-ultrasound Guidance on Patients with Intertrochanteric Fracture of Femur and Its Effect on Serum ICAM-1 Level

目的:探讨B超引导下神经阻滞麻醉对股骨粗隆间骨折患者的麻醉效果及对血清细胞粘附分子-1(intercellular adhesion molecule-1,ICAM-1)水平的影响.方法:选择2017年1月-2019年3月在本院行股骨粗隆间骨折手术的患者90例,根据麻醉方式不同分为观察组和对照组,各45例.对照组给予蛛网膜下腔-硬膜外联合阻滞麻醉,观察组给予B超引导下腰丛复合坐骨神经阻滞麻醉.观察两组麻醉效果、术中血压水平变化、疼痛评分、免疫情况、血清ICAM-1水平以及并发症情况.结果:观察组运动、感觉神经阻滞麻醉起效时间均短于对照组,维持时间均长于对照组,差异均有统计学意义(P<0.05);两组麻醉前、麻醉后2 h血氧饱和度(SpO2)、心率(HR)、收缩压(SBP)、舒张压(DBP)水平比较,差异均无统计学意义(P>0.05);观察组术后2、12、24 h视觉模拟评分法(VAS)评分均显著低于对照组(P<0.05);两组术后2 h CD4+、CD4+/CD8+水平均较术前下降,且对照组下降显著(P<0.05),术后12、24 h CD4+、CD4+/CD8+逐渐升高,观察组各时间点均高于对照组,差异均有统计学意义(P<0.05);两组麻醉后2 h、术后4 h ICAM-1水平均升高,且对照组升高更显著,差异均有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05).结论:B超引导下神经阻滞麻醉对股骨粗隆间骨折患者的镇痛效果较好,起效较快,维持时间长,并且对免疫功能影响较小,对血清炎症因子水平影响较小,并发症较少,在临床上可广泛使用.

Objective:To investigate the anesthesia effect of nerve block anesthesia under B-ultrasound guidance on the patients with intertrochanteric fracture of femur and Its effect on the serum Intercellular adhesion molecule-1(ICAM-1)level.Method:From January 2017 to March 2019,90 patients with intertrochanteric fracture of femur in our hospital were selected and divided into observation group and control group according to the anesthesia mode of the patients,45 cases in each group.The control group was given subarachnoid block combined with epidural anesthesia,and the observation group was given lumbar plexus combined with sciatic nerve block under B-ultrasound guidance.The anesthesia effect,intraoperative blood pressure,pain score,immune status,serum ICAM-1 level and complications of two groups were observed.Result:The onset time of motor and sensory nerve block anesthesia in the observation group were shorter than those in the control group,and the maintenance time were longer than those in the control group(P<0.05).There were no significant differences in SpO2,HR,SBP and DBP between two groups before and 2 h after anesthesia(P>0.05).The VAS scores of the observation group at 2,12 and 24 h after operation were significantly lower than those in the control group(P<0.05).And the levels of CD4+,CD4+/CD8+in two groups at 2 h after operation decreased significantly,the control group decreased significantly(P<0.05),and the levels of CD4+,CD4+/CD8+increased gradually at 12,24 h after operation,all time points in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).At 2 h after anesthesia and 4 h after operation,the levels of ICAM-1 in two groups increased significantly,the control group increased more significantly,the differences were statistically significant(P<0.05).And the complication rate in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Under B-ultrasound guidance,nerve block anesthesia has a better analgesic effect on the patients with intertrochanteric fracture of femur,with a faster onset,a longer maintenance time,a smaller impact on immune function,a smaller impact on the level of serum inflammatory factors,and fewer complications,which can be widely used in clinical.