区域神经阻滞技术在创伤胫腓骨骨折老年患者麻醉中的应用

The regional nerve block technique for anesthesia in elderly patients with traumatic tibia and fibula fractures

目的探讨区域神经阻滞技术在创伤胫腓骨骨折老年患者麻醉中的应用效果。方法选择93例行手术治疗的老年胫腓骨骨折患者, 随机分为观察组和对照组, 分别47例、46例, 对照组行全身麻醉, 观察组行区域神经阻滞麻醉。结果两组手术时间比较并无差异[(42.2±5.4)min和(43.3±5.7)min, t=0.953, P=0.343], 观察清醒时间[(11.2±2.6)min和(14.5±2.8)min, t=5.714, P<0.001]、术中输液量[(415.6±27.5)ml/L和(686.6±36.3)ml/L, t=40.626, P<0.001]均低于对照组;患者手术各时点切皮时、上固定物、手术结束时、术后30 min血压、呼吸水平均低于对照组, 血糖、白介素-6(IL-6)、血清皮质醇均高于对照组(P<0.05);观察组并发症发生率为2.13%、对照组为15.22%(χ^(2)=5.07, P<0.05)。结论创伤胫腓骨骨折老年患者使用区域神经阻滞技术麻醉效果好, 血流动力学指标较稳定, 应激反应轻, 不良反应小。

Objective To explore the effect of regional nerve block anesthesia for elderly patients with traumatic tibia and fibula fractures.Methods Ninety-three elderly patients with tibia and fibula fractures undergone surgical treatment were randomly divided into an observation group and a control group,with 47 and 46 patients,respectively,in each group.The control group received general anesthesia and the observation group received a regional nerve block.Results There was no difference in operative time between the two groups(42.2±5.4)min and(43.3±5.7)min,t=0,953 P=0.343.[The time to recovery of consciousness(11.2±2.6)min and(14.5±2.8)min.1=5.714,P<0.001]and the volume of intraoperative infusion[(415.6±27.5)ml/L and(686.6+36.3)ml/L.t=40.626,P<0.001]were lower and patients'blood pressure and respiratory rate were also lower at skin incision fracture fixation,end of surgery and 30 min after surgery in the observation group than in the control group.The levels of Glu.IL-6 and COR were higher than those in the control group(all P<0.05).The incidence of complications was 2.13%in the observation group and 15.22%in thecontrol group(X^(2)=5.07.P<0.05).Conclusions Elderly patients with traumatic tibia and fibula fractures receive beneficial anesthetic effects with the regional nerve block technique,with stable hemodynamics,mild stress response and minor adverse reactions.