超声引导下股神经及坐骨神经阻滞用于老年下肢骨折患者的麻醉效果及对血凝状态的影响

Effect of ultrasound-guided femoral nerve and sciatic nerve block on anesthetic effect and blood coagulation state in elderly patients with lower limb fracture

目的探讨超声引导下股神经及坐骨神经阻滞用于老年下肢骨折患者的麻醉效果及对血凝状态的影响。方法选取2018年1月至2020年12月该院骨外科收诊的120例老年下肢骨折患者,按照随机数表法分为观察组与对照组,各60例。术中对照组施行腰硬联合麻醉,观察组施行超声引导下股神经及坐骨神经阻滞,比较两组的麻醉效果、生命体征指标、阻滞起效时间、阻滞持续时间、麻醉不良反应发生率、术后恢复时间、凝血功能指标。结果观察组与对照组麻醉优良率无明显差异(96.67%vs.93.33%,P>0.05)。两组麻醉后平均动脉压、心率与麻醉前比较均无明显差异(P>0.05),且麻醉前、后两组间比较亦均无明显差异(P>0.05)。两组感觉神经阻滞起效时间、运动神经阻滞起效时间、感觉神经阻滞持续时间及运动神经阻滞持续时间均无明显差异(P>0.05)。两组术中寒战、恶心呕吐、头痛发生率无明显差异(P>0.05),观察组术中低血压、心动过缓发生率均明显低于对照组(P<0.05)。观察组术后排尿恢复时间、下肢运动恢复时间均较对照组明显缩短(P<0.05)。术后1 h观察组凝血酶时间(TT)、凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)均较对照组明显延长(P<0.05)。结论在保证麻醉效果、维持术中生命体征稳定的前提下,超声引导下股神经联合坐骨神经阻滞可有效减少麻醉不良反应的发生,缩短患者术后恢复时间,减轻患者血液高凝状态。

Objective To explore the effect of ultrasound-guided femoral nerve and sciatic nerve block on anesthetic effect and blood coagulation state in elderly patients with lower limb fracture.Methods From January 2018 to December 2020,a total of 120 elderly patients with lower limb fractures admitted to the Department of Orthopaedics of this hospital were included and divided into the observation and control group according to the method of random number table,with 60 cases in each group.During the operation,the patients in the control group were given combined spinal-epidural anesthesia,while the patients in the observation group were given ultrasound-guided femoral nerve and sciatic nerve block.The anesthetic effect,vital signs,block onset time,block duration,anesthesia adverse reactions rate,postoperative recovery time and coagulation function indexes were compared between the two groups.Results There was no significant difference in the excellent and good rate of anesthesia between the observation group and the control group(96.67%vs.93.33%,P>0.05).Compared with before anesthesia,the mean arterial pressure and heart rate of the two groups did not change significantly(P>0.05),and there was no significant difference between the two groups before and after anesthesia(P>0.05).No significant difference was found in the sensory nerve block onset time,motor nerve block onset time,sensory nerve block duration and motor nerve block duration between the observation group and the control group(P>0.05).There was no significant difference in the incidence of shivering,nausea and vomiting,and headache between the two groups(P>0.05).The incidences of intraoperativehypotension and bradycardia in the observation group was lower than those in the control group(P<0.05).The micturition recovery time and lower limb movement recovery time in the observation group were shorter than those in the control group(P<0.05).The thrombin time(TT),prothrombin time(PT)and activated partial thromboplastin time(APTT)in the observation group at 1 h after operation were significantly longer than those in the control group(P<0.05).Conclusion Under the premise of ensuring the anesthetic effect and maintaining the stability of vital signs during operation,ultrasound-guided femoral nerve combined with sciatic nerve block can effectively reduce the occurrence of adverse reactions caused by anesthesia,shorten the postoperative recovery time,and relieve the blood hypercoagulable state of patients.