不同浓度罗哌卡因腰丛神经阻滞对老年股骨颈骨折患者血流动力学及镇痛效果的影响

Effect of lumbar plexus block with different concentrations of ropivacaine on hemodynamics and analgesia in elderly patients with femoral neck fracture

目的:探讨针对行手术治疗的老年股骨颈骨折患者应用不同浓度罗哌卡因腰丛神经阻滞对其血流动力学及镇痛效果的影响。方法:选取本院2018年6月—2019年12月97例行手术治疗老年股骨颈骨折患者,根据随机数字表法分为观察组48例和对照组49例,全部患者均接受罗哌卡因腰丛神经阻滞麻醉,对照组采用0.35%罗哌卡因,观察组采用0.25%罗哌卡因。对比两组血流动力学[气管插管时(T0)、手术切皮时(T1)、切口缝合时(T2)、麻醉苏醒后20 min(T3)]等不同时间点心率(HR)、平均动脉压(MAP)指标水平;对比两组术后4、12及48 h视觉疼痛模拟评分(VAS);比较两组拔管、下床活动及住院时间;比较两组麻醉药物用量。结果:相比对照组,观察组T1、T2、T3时期MAP较高,HR较慢(P<0.05);两组患者术后4、12及48 h VAS、拔管、下床活动及住院时间比较,差异无统计学意义(P>0.05);两组术中舒芬太尼追加剂量及术后24 h镇痛泵药物使用量比较,差异无统计学意义(P>0.05)。结论:针对老年股骨颈骨折患者采取罗哌卡因腰丛神经阻滞,有较好镇痛效果,能够减少心率、血压波动,使血液动力学稳定,有利于患者恢复,而0.25%浓度罗哌卡因对血液动力学稳定性更佳。

Objective:To investigate the effect of ropivacaine lumbar plexus block on hemodynamics and analgesia in elderly patients with femoral neck fracture treated by surgery.Methods:A total of 97 elderly patients who underwent surgery for femoral neck fracture in our hospital from June 2018 to December 2019 were selected and divided into the observation group(n=48)and the control group(n=49)according to the random number table method.All patients received ropivacaine lumbar plexus block anesthesia.The control group was treated with 0.35%ropivacaine,and 0.25%ropivacaine was used in the observation group.The levels of dim sum rate(HR)and mean arterial pressure(MAP)were compared between the two groups,such as T0 of endotracheal intubation,skin incision(T1),incision suture(T2),and 20 min after anesthesia recovery(T3).The visual pain simulation scores at 4 h,12 h,and 48 h after operation were compared between the two groups.Extubation,out-of-bed activity,and length of hospital stay were compared between the two groups.The dosage of anesthetic drugs was compared between the two groups.Results:Compared with the control group,MAP was higher,and HR was slower in the observation group at T1,T2,and T3 periods,respectively(P<0.05).There were no significant differences in VAS,extubation,out-of-bed activity,and length of hospital stay in both groups at 4,12,and 48 h after surgery(P>0.05).There was no significant difference in the additional intraoperative dose of sufentanil,and the amount of analgesia pump drugs used 24 h after operation between the two groups(P>0.05).Conclusion:For elderly patients with a femoral neck fracture,ropivacaine lumbar plexus block has a good analgesic effect and can reduce the fluctuation of heart rate and blood pressure and make hemodynamics stable,which is beneficial to the recovery of patients.The 0.25%concentration of ropivacaine has better hemodynamic stability.