B超引导下腰丛-坐骨神经阻滞用于老年股骨粗隆间骨折患者手术中的有效性和安全性

Efficacy and safety of B-ultrasound-guided lumbar plexus sciatic nerve block in elderly patients with intertrochanteric fracture

目的探讨B超引导下腰丛-坐骨神经阻滞用于老年股骨粗隆间骨折患者手术中的有效性和安全性。方法选取我院2019年1月至2020年1月收治的76例老年股骨粗隆间骨折患者,采用机械取样法将其分为观察组(38例,B超引导下腰丛-坐骨神经阻滞)和对照组(38例,腰硬联合麻醉)。比较两组的麻醉效果。结果观察组运动、感觉神经阻滞维持时间均长于对照组,起效时间均短于对照组(P<0.05)。手术后1 d,两组的IgM、IgE、IgG水平均降低,但观察组明显高于对照组(P<0.05)。T1、T2、T3时,观察组的HR、MAP均明显高于对照组(P<0.05)。观察组的麻醉不良反应总发生率明显低于对照组(P<0.05)。结论应用B超引导下腰丛-坐骨神经阻滞有助于稳定老年股骨粗隆间骨折患者的血流动力学指标与免疫球蛋白水平,保证麻醉安全性。

Objective To investigate the efficacy and safety of B-ultrasound-guided lumbar plexus sciatic nerve block in elderly patients with intertrochanteric fractures.Methods A total of 76 elderly patients with intertrochanteric fracture enrolled in our hospital from January 2019 to January 2020 were selected,and the patients were divided into observation group(38 cases,B-ultrasound-guided lumbar plexus sciatic nerve block)and control group(38 cases,combined spinal and epidural anesthesia)by mechanical sampling.The anesthetic effects of the two groups were compared.Results The duration of motor and sensory nerve block in the observation group were longer than those in the control group,and the onset time were shorter than those in the control group(P<0.05).At 1 d after operation,the levels of IgM,IgE and IgG in the two groups decreased,but those in the observation group were significantly higher than the control group(P<0.05).At T1,T2 and T3,HR and MAP in the observation group were significantly higher than those in the control group(P<0.05).The total incidence of adverse anesthetic reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion The application of B-ultrasound-guided lumbar plexus sciatic nerve block is helpful to stabilizing the hemodynamic indexes and immunoglobulin levels in elderly patients with intertrochanteric fractures,and ensuring the safety of anesthesia.