髂筋膜阻滞与椎管内麻醉对股骨粗隆间骨折应激的影响

A comparative study on the effect of iliac fascia block and intraspinal anesthesia on the stress in patients with femoral intertrochanteric fractures

目的研究髂筋膜阻滞与椎管内麻醉对行手术治疗的股骨粗隆间骨折患者机体应激的影响。方法选择股骨粗隆间骨折患者80例,根据麻醉方式的不同分为髂筋膜阻滞组与椎管内麻醉组,各40例。髂筋膜阻滞组予髂筋膜间隙阻滞,椎管内麻醉组给予麻醉,检测甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)水平,评估麻醉效果、疼痛评分,观察手术恢复指标与并发症发生情况。结果髂筋膜阻滞组拔管后NE、E、Cor水平、疼痛评分低于椎管内麻醉组(P<0.05)。髂筋膜阻滞组拔管、麻醉苏醒需要时间,躁动评分低于椎管内麻醉组(P<0.05)。髂筋膜阻滞组可以下床活动时间、住院需要时间短于椎管内麻醉组(P<0.05)。髂筋膜阻滞组并发症发生率低于椎管内麻醉组(P<0.05)。结论髂筋膜阻滞与椎管内麻醉比较,能改善股骨粗隆间骨折手术患者应激水平,麻醉效果显著,可缓解患者疼痛,促进患者术后恢复,降低手术并发症发生。

Objective To study the effect of the iliac fascia block and intraspinal anesthesia on the stress in patients with femoral intertrochanteric fractures undergoing a surgical treatment.Methods A total of 80 patients with femoral intertrochanteric fractures were selected and divided into an iliac fascia block group and an intraspinal anesthesia group according to different anesthesia methods,with 40 cases in each group.The levels of norepinephrine(NE),epinephrine(E),and cortisol(Cor)were detected in the two groups,and their anesthesia effects and pain scores were evaluated,and the operation recovery indexes and complication incidence were observed.Results The levels of NE,E,Cor and pain scores after extubation in the iliac fascia block group were lower than those in the intraspinal anesthesia group(P<0.05).The time required for extubation and anesthesia recovery,and the scores of agitation in the iliac fascia block group were lower than those in the intraspinal anesthesia group(P<0.05).The time to get out of bed and the time required for hospitalization in the iliac fascia block group were shorter than those in the intraspinal anesthesia group(P<0.05).The incidence of complications in the iliac fascia block group was lower than that in the intraspinal anesthesia group(P<0.05).Conclusion Compared with the intraspinal anesthesia,the iliac fascia block can achieve a significant anesthesia effect,improve the stress level of patients with intertrochanteric fractures of femur,relieve the pains,promote the recovery,and reduce the incidence of surgical complications.