超声引导下腰骶丛神经阻滞复合小剂量丙泊酚对老年股骨颈骨折患者麻醉阻滞效果及术中血流动力学的影响

Effects of Ultrasound-guided Lumbosacral Plexus Block Combined with Low-dose Propofolon the Effect of Anesthesia Block and Intraoperative Hemodynamics in Elderly Patients withFemoral Neck Fracture

目的:探讨超声引导下腰骶丛神经阻滞复合小剂量丙泊酚对老年股骨颈骨折患者麻醉阻滞效果及术中血流动力学的影响。方法:选取2018年4月至2020年3月我院老年股骨颈骨折患者68例,按随机数字表法分观察组(34例)、对照组(34例)。均行全髋关节置换术,对照组予以静脉全麻,观察组予以超声引导下腰骶丛神经阻滞复合小剂量丙泊酚麻醉,对比两组并发症发生率、麻醉阻滞效果[术前、术中植假体时、术后30min警觉/镇静(OAA/S)评分]、血流动力学[平均动脉压(MAP)、心率(HR)]。结果:术中植假体时观察组OAA/S评分低于对照组,术后30min OAA/S评分高于对照组(P<0.05);术中植假体时、术后30min MAP、HR升高,但观察组变化幅度小于对照组(P<0.05);观察组并发症发生率2.94%(1/34)与对照组5.88%(2/34)对比,差异无统计学意义(P>0.05)。结论:老年股骨颈骨折患者术中予以超声引导下腰骶丛神经阻滞复合小剂量丙泊酚可提高麻醉效果,降低对术中血流动力学影响且不增加并发症发生风险。

Objective:To investigate the effect of ultrasound-guided lumbar-sacral plexus block combined with low-dose propofol on anesthesia block effect and intraoperative hemodynamics in elderly patients with femoral neck fracture.Methods:From April 2018 to March 2020,68 elderly patients with femoral neck fractures in our hospital were selected and divided into observation group(34 cases)and control group(34 cases)according to random number table method.All hip replacements were performed,the control group was given intravenous anesthesia,and the observation group was anesthetized with ultrasound-guided lumbar sacral plexus block combined with low-dose propofol.Comparing the incidence of complications,anesthesia block effect[preoperative,intraoperative prosthesis implantation,30min postoperative alertness/sedation(OAA/S)score],hemodynamics[mean arterial pressure(MAP),heart rate(HR)]in the two groups.Results:The OAA/S score of the observation group was lower than that of the control group during implantation of the prosthesis,and the OAA/S score was higher than that of the control group at 30 minutes after the operation(P<0.05);MAP and HR increased during implantation during operation and 30 minutes after operation,but the change in the observation group was smaller than that in the control group(P<0.05);the incidence of complications in the observation group was 2.94%(1/34)compared with 5.88%(2/34)in the control group,with no significant difference(P>0.05).Conclusion:Ultrasoundguided lumbosacral plexus block combined with low-dose propofol in elderly patients with femoral neck fracture can improve the anesthesia effect,reduce the impact on intraoperative hemodynamics and not increase the risk of complications.