术前连续股神经阻滞在老年髋部骨折患者救治绿色通道中的应用

目的探讨术前连续股神经阻滞在老年髋部骨折患者救治绿色通道中的应用。方法选取2017年5月至2019年5月髋部骨折患者120例,根据患者镇痛意愿分为静脉镇痛组37例、术后股神经阻滞组41例、术前股神经阻滞组42例。静脉镇痛组接受常规治疗,术前1 h口服塞来昔布,术后传统自控静脉镇痛;术后股神经阻滞组接受绿色通追流程,术前1 h口服塞来昔布,术后连续股神经阻滞镇痛;术前股神经阻滞组接受绿色通道流程,术前和术后均连续股神经阻滞镇痛。比较各組手术等待时间、手术时间、术后首次下床时间及住院时间,拔管时间、清醒时间,比较各组术后6h、12h、24h、48 h、72 h视觉模拟评分法(VAS)评分及住院期间并发症发生情况。结果术前股神经阻滞组、术后股神经阻滞组手术等待时间、术后首次下床时间、住院时间均短于静脉镇痛组(P<0.05);术后不同时间点,术前股神经阻滞组VAS评分均低于静脉镇痛组和术后股神经阻滞组(P<0.05);术前股神经阻滞组、术后股神经阻滞组肺部感染发生率、切口感染发生率均低于静脉镇痛组(P<0.05)。结论绿色通道下行术前连续股神经阻滞镇痛,能有效缩短老年髋部骨折患者手术等待时间,降低术后疼痛程度,降低并发症发生率,,促进患者早期康复。

Objective To explore the application of preoperative continuous femoral nerve block(CFNB)in green channel treatment of elderly patients with hip fracture.Methods 120 patients with hip fracture who were admitted to the hospital between May 2017 and May 2019 were selected.According to the diagnosis and treatment process and the patients'intention of analgesia,they were divided into the intravenous analgesia group(37 cases)the postoperative femoral nerve block group(41 cases),and the preoperative femoral nerve block group(42 cases).The intravenous analgesia group underwent routine diagnosis and treatment procedures,orally took celecoxib at 1 hour before operation,and were given traditional patient-controlled intravenous analgesia after operation.The postoperative femoral nerve block group underwent green channel procedures,orally took celecoxib at 1 hour before operation,and were given femoral nerve block after operation.The preoperative femoral nerve block group underwent green channel procedures and were given CFNB before and after operation.The waiting time for operation,operation time,the initial leaving bed time after operation,hospital stay,extubation time,awake time and use of propofol were compared among groups.The scores of visual analogue scale(VAS)at 6 h;12 h,24 h,48 h and 72 h after operation,and occurrence of complications during hospitalization were also compared among groups.Results The median waiting time for operation,the initial leaving bed time after operation and hospital stay of the preoperative femoral nerve block group and the postoperative femoral nerve block group were significantly shorter than those of the intravenous analgesia group(P<0.05).The agitation score in the preoperative femoral nerve block group were significantly lower than those in the intravenous analgesia group and the postoperative femoral nerve block group(P<0.05).VAS scores of the preoperative femoral nerve block group were significantly lower than those of the intravenous analgesia group and the postoperative femoral nerve block group at different time points after operation(P<0.05).At 6 h,12 h and 24 h after operation,the incidence rates of pulmonary infection and incision infection in the preoperative femoral nerve block group and the postoperative femoral nerve block group were significantly lower than those in the intravenous analgesia group(P<0.05).Conclusion The preoperative CFNB under green channel can effectively shorten the waiting time for operation of elderly patients with hip fracture,reduce their postoperative pain degree and the incidence of complications,and promote their early rehabilitation.