“沙漏征”髂筋膜阻滞联合骶丛阻滞对老年股骨颈骨折患者围术期快速康复的影响

Effect of "hourglass-pattern" fascia iliac block combined with sacral plexus block on perioperative rapid recovery in elderly patients with fracture of neck of femur

目的探讨“沙漏征”髂筋膜阻滞联合骶丛阻滞对老年股骨颈骨折患者术后神经认知功能、睡眠质量和快速康复的影响。方法选取2019年3月至2020年7月保定市第一中心医院择期行股骨颈骨折闭合复位内固定术的老年患者80例,应用随机数字表法将其分为“沙漏征”髂筋膜阻滞联合骶丛阻滞组(S组)和全身麻醉组(G组)。最终有效收集78例,S组38例,G组40例。对比两组术前(T0)、入麻醉恢复室(postanesthesia care unit, PACU)后30 min(T1)、术后24 h(T4)、术后72 h(T6)的简易精神状况检查表(mini-mental state examination, MMSE)评分;对比两组睡眠质量、首次下床活动时间、住院时间;记录两组术后4 h(T2)、12 h(T3),T4,术后48 h(T5)的视觉模拟评分(visual analogue score, VAS),比较两组不良反应发生率。结果 S组术后T1、T4时点MMSE评分高于G组(P<0.05)。G组T1、T4时点MMSE评分低于同组T0(P<0.05)。S组T1、T4的神经认知紊乱发生率(15.1%、7.9%)低于G组(27.5%、15.0%,P<0.05)。S组术后匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PQSI)量表评分低于G组(P<0.05),患者首次下床活动时间早于G组(P<0.01),住院时间短于G组(P<0.05)。S组T2、T3、T4、T5时点VAS低于G组(P<0.05),恶心、呕吐等不良反应发生率低于G组(P<0.05)。结论“沙漏征”髂筋膜阻滞联合骶丛阻滞麻醉方法对老年股骨颈骨折患者术后神经认知功能影响小,改善围术期睡眠质量,术后镇痛效果好,不良反应少,有助于患者快速康复,缩短住院时间。

Objective To explore the effect of "hourglass-pattern" fascia iliac block combined with sacral plexus block on postperative neurocognitive function, sleep quality and rapid recovery in elderly patients with fracture of neck of femur.Methods Eighty elderly patients(ASA class □-□, 63-79 years old) with hip fracture scheduled for closed reduction and internal fixation were selected, and according to the random number table, they were divided into "hourglass-pattern" fascia iliac block combined with sacral plexus block group(group S) and general anesthesia group(group G). Finally, 78 cases were collected effectively, including 38 cases in group S and 40 cases in group G. The mini-mental state examination(MMSE)scores before surgery(T0), 30 minutes in PACU(T1), on the first day after surgery(T4), and on the third day after surgery(T6)were compared between the two groups. The perioperative sleep quality, the time of first getting out of bed and the hospitalization time were recorded and compared between the two groups. The visual analogue score(VAS) were recorded at4 h(T2), 12 h(T3), T4 and 48 h(T5) after operation in both groups, and the incidence of adverse reactions were compared between the two groups. Results The MMSE scores in group S were higher than those of group G at T1 and T4(P<0.05). In Group G, the MMSE scores at T1 and T4 were lower than those at T0(P<0.05). And the incidence of cognitive dysfunction in group S(15.1%, 7.9%) was lower than those of group G at T1 and T4(27.5%, 15.0%, P<0.01). The Pittsburgh sleep quality index(PQSI) in group S was lower than that in group G(P<0.05). The time of first getting out of bed was significantly earlier than that of group G(P<0.01), and the hospitalization time in group S was shorter than that of group G(P<0.05). The VAS scores of T2, T3, T4 and T5 in Group S were lower than those in group G(P<0.05), and the incidence of adverse reactions were lower in group S than that in group G(P<0.05). Conclusions "Hourglass-pattern" fascia iliac block combined with sacral plexus block has little effect on postperative neurocognitive function of the elderly patients with hip fracture. It can improve perioperative sleep quality, provide good postoperative analgesia effect, and has fewer adverse reactions which is helpful for perioperative rapid recovery.