超声引导下行腰丛复合坐骨神经阻滞麻醉应用于老年股骨粗隆间骨折手术的效果

The Effect of Ultrasound-guided Lumbar Plexus Combined with Sciatic Nerve Block Anesthesia in the Operation of Elderly Femoral Intertrochanteric Fractures

目的探讨超声引导下行腰丛复合坐骨神经阻滞麻醉应用于老年股骨粗隆间骨折手术的效果。方法方便选取2018年1月—2020年2月江苏省海门市第二人民医院收治的老年股骨粗隆间骨折手术患者76例,按照随机数字表法,分为对照组与观察组,各38例。对照组麻醉方式为蛛网膜下腔阻滞麻醉复合硬膜外麻醉,观察组麻醉方式为超声引导下行腰丛复合坐骨神经阻滞麻醉。比较两组麻醉效果与不良反应发生情况。结果观察组感觉、运动神经阻滞起效时间分别为(6.55±1.20)、(10.41±1.87)min,均短于对照组,差异有统计学意义(t=10.527、9.090,P<0.05);观察组维持时间分别为(271.89±50.05)、(250.20±38.47)min,均长于对照组,差异有统计学意义(t=4.037、6.635,P<0.05);观察组术后2、12、24 h的视觉模拟评分法(VAS)评分均低于对照组,差异有统计学意义(t=6.987、6.440、13.271,P<0.05);观察组不良反应发生率为5.26%,低于对照组的21.05%,差异有统计学意义(χ^(2)=4.146,P<0.05)。结论超声引导下行腰丛复合坐骨神经阻滞麻醉应用于老年股骨粗隆间骨折手术的效果确切,具备较快的神经阻滞起效速度,且作用维持时间长,可明显减轻术后疼痛,且不良反应少。

Objective To investigate the effect of ultrasound-guided lumbar plexus combined with sciatic nerve block anesthesia in the operation of elderly femoral intertrochanteric fractures.Methods 76 elderly patients undergoing intertrochanteric fracture surgery from January 2018 to February 2020 in the Second People's Hospital of Haimen City,Jiangsu Province,were conveniently selected and divided into a control group and an observation group,with 38 cases in each according to the random number table method.The anesthesia method of the control group was subarachnoid block anesthesia combined with epidural anesthesia,and the anesthesia method of the observation group was ultrasound-guided lumbar plexus combined sciatic nerve block anesthesia.The effects of anesthesia and the occurrence of adverse reactions between the two groups were compared.Results The onset time of sensory and motor nerve block in the observation group was(6.55±1.20)min and(10.41±1.87)min,which were shorter than those in the control group,and the difference was statistically significant(t=10.527,9.090,P<0.05);the maintenance time of the observation group was respectively(271.89±50.05)min and(250.20±38.47)min,which were both longer than the control group,the difference was statistically significant(t=4.037,6.635,P<0.05);the observation group at 2 h,12 h,24 h after surgery The visual analogue scoring method(VAS)scores were lower than those of the control group,and the difference was statistically significant(t=6.987,6.440,13.271,P<0.05);the adverse reaction rate of the observation group was 5.26%,which was lower than 21.05%of the control group.The difference was statistically significant(χ^(2)=4.146,P<0.05).Conclusion Ultrasound-guided lumbar plexus combined sciatic nerve block anesthesia is effective for elderly femoral intertrochanter fracture surgery.It has a faster onset of nerve block and a long duration of action,which can significantly reduce postoperative pain,with few adverse reactions.