舒芬太尼对老年髋部骨折患者的麻醉效果及感觉阻滞时间、运动阻滞时间的影响

Anesthetic effect of sufentanil on elderly patients with hip fracture and the influence on sensory block time and motor block duration

目的分析舒芬太尼对老年髋部骨折患者的麻醉效果及感觉阻滞时间、运动阻滞时间的影响,为临床麻醉提供依据。方法选取2018年12月至2019年12月在通用环球中铁西安医院接受治疗的80例老年髋部骨折患者作为研究对象,按随机数表法分为对照组和观察组各40例。对照组患者的麻醉药物为0.4%罗哌卡因麻醉液2.5 mL,观察组患者的麻醉药物为含有5μg舒芬太尼的0.4%罗哌卡因麻醉液2.5 mL。比较两组患者的痛觉阻滞起效时间、运动阻滞持续时间、运动阻滞起效时间、第十二节胸椎(T12)处镇痛持续时间、运动阻滞完全时间、感觉阻滞持续时间,手术前后比较两组患者的静息及活动状态下视觉模拟评分(VAS)和并发症发生情况。结果观察组患者的痛觉阻滞起效时间、运动阻滞持续时间分别为(38.01±15.52)s、(135.00±29.11)min,明显短于对照组的(62.70±18.80)s、(197.92±36.44)min,而运动阻滞起效时间、T12处镇痛持续时间、运动阻滞完全时间、感觉阻滞持续时间分别为(6.99±2.50)min、(317.48±41.88)min、(17.46±3.53)min、(501.45±68.90)min,明显长于对照组的(4.04±1.81)min、(186.40±39.75)min、(10.55±2.53)min、(288.03±43.82)min,差异均有统计学意义(P<0.05);术前,两组患者在静息状态及活动状态下的VAS疼痛评分比较差异均无统计学意义(P>0.05);术后24 h,观察组患者在静息状态及活动状态下的VAS疼痛评分分别为(2.06±0.52)分、(3.95±1.02)分,明显低于对照组的(3.77±0.85)分、(6.08±1.33)分,差异均有统计学意义(P<0.05);观察组患者术后的并发症发生率为7.5%,略低于对照组的12.5%,但差异无统计学意义(P>0.05)。结论舒芬太尼应用于老年髋部骨折麻醉可明显缩短患者的运动阻滞时间、延长感觉阻滞时间,降低疼痛及并发症发生率,值得临床中推广应用。

Objective To analyze the anesthetic effect of sufentanil on elderly patients with hip fracture and the influence on sensory block time and motor block duration,so as to provide basis for clinical anesthesia.Methods From December 2018 to December 2019,80 elderly patients with hip fracture in Department of Anesthesia,General Global China Railway Xi’an Hospital were selected as the research objects.They were randomly divided into a control group and an observation group,with 40 patients in each group.The control group was given 2.5 mL of 0.4%ropivacaine anesthesia solution,while the observation group was given 2.5 m L of 0.4%ropivacaine anesthesia solution with 5μg sufentanil.The onset time of pain block,duration of motor block,onset time of motor block,duration of T12 analgesia,complete time of motor block,duration of sensory block,the Visual Analogue Scale(VAS)before and after operation,and complications of the two groups were compared.Results The onset time of pain block and duration of motor block in the observation group were(38.01±15.52)s and(135.00±29.11)min respectively,which were significantly shorter than(62.70±18.80)s and(197.92±36.44)min in the control group,while the onset time of motor block,duration of T12 analgesia,complete time of motor block,and duration of sensory block were(6.99±2.50)min,(317.48±41.88)min,(17.46±3.53)min,and(501.45±68.90)min,respectively,which were significantly longer than(4.04±1.81)min,(186.40±39.75)min,(10.55±2.53)min,and(288.03±43.82)min in the control group(P<0.05).Before operation,there was no significant difference in VAS score between the two groups in resting state and active state(P>0.05);24 hours after operation,the VAS scores of the observation group in the resting state and active state were(2.06±0.52)points and(3.95±1.02)points,respectively,which were significantly lower than(3.77±0.85)points and(6.08±1.33)points in the control group(P<0.05).The complication rate of the observation group was 7.5%,which showed no statistically significant difference with12.5%of the control group(P>0.05).Conclusion Sufentanil has a significant anesthetic effect on elderly patients with hip fracture,which can significantly shorten the motor block time,prolong the sensory block time,reduce the incidence of pain and complications,and is worthy of clinical application.