加速康复外科理念下不同麻醉方式对下肢骨折围术期镇痛和早期康复的影响

Effects of Different Anesthesia M`ethods on perioperative analgesia and early rehabilitation in patients with lower limb fracture operation under the theory of enhanced recovery after surgery

目的:比较加速康复外科理念下不同麻醉方式对下肢骨折手术患者围术期镇痛和早期康复的影响.方法:择期行下肢骨折切开复位内固定术的患者120例,年龄18-72岁,BMI21-28kg/m^2,ASAI-III级,按麻醉方式不同分为3组(n=40):蛛网膜下腔阻滞麻醉组(A组),单纯全身麻醉组(B组),神经阻滞复合全身麻醉组(C组).A组:L3-4间隙穿刺,蛛网膜下腔注射0.375%布比卡因10mg;B组:静吸复合喉罩全身麻醉;C组:超声引导下行患侧髂筋膜和坐骨神经阻滞复合喉罩七氟烷吸入麻醉.术毕予以静脉自控镇痛.记录术中不同时间点的MAP、HR波动情况;术后不同时间点的VAS静息,VAS运动评分和BCS舒适度评分;术后不良反应发生情况,术后首次下床时间,肠蠕动恢复时间和术后住院时间.结果:与A组和B组相比,C组术中血流动力学相对稳定;VAS静息和VAS运动评分降低,BCS舒适度评分升高;术后不良反应发生率明显降低;术后首次下床时间,肠蠕动恢复时间,术后住院时间明显缩短(P<0.05).结论:在加速康复理念下,神经阻滞复合全身麻醉用于下肢骨折手术患者,围术期镇痛和早期康复效果明显优于蛛网膜下腔阻滞麻醉和单纯全身麻醉.

Objective:To compare the effects of different anesthesia methods on perioperative analgesia and early rehabilitation in patients with lower limb fracture operation under the theory of enhanced recovery after surgery.Methods:120 patients,ASA physical statusⅠ〜Ⅲ,aged 18〜72 yr,with body mass index of 21〜28 kg/m^2,scheduled for lower limb fracture operation were divided into three groups(n=40).Spinal analgesia group(group A),simple general anesthesia group(group B),and nerve block combined with general anesthesia group(group C).Lumbar puncture at the L3〜4 interspinous spaces wasperformed in Group A,then given bupivacaine lOmg into the subarachnoid space;Patients in group B received intravenous-inhalational anesthesia;Patients in group C received Ultrasound-guided fascia iliaca compartment and sciatic nerve block combined with sevoflurane inhalation anesthesia.Patient-controlled intravenous analgesia was provided to all the patients after surgery.The mean arterial pressure(MAP)and heart rate(HR),VAS quiescence and motion scores and BCS comfort score on different point were recorded,as well as the occurrence of postoperative adverse reaction.The early down time,the gastrointestinal function recovery,and the postoperative hospitalization time were also recorded.Results:Compared with group A and group B,the intraoperative hemodynamics was relatively stabled;the VAS quiescence and motion scores were decreased;the BCS comfort scores was increased;the incidence of postoperative adverse reactions was reduced;the early down time,the gastrointestinal function recovery,and the postoperative hospitalization time were significantly shortened in group C(P<0.05).Conclusion:Nerve block combined with general anesthesia for lower limb fracture operation provides better perioperative analgesia and early rehabilitation than subarachnoid block anesthesia and simple general anesthesia.