超声引导下髂筋膜间隙阻滞复合喉罩全身麻醉在老年股骨粗隆间骨折手术患者中的应用效果

Application effects of ultrasound-guided fascia iliaca compartment block combined with laryngeal mask general anesthesia in elderly patients with femoral intertrochanteric fracture surgeries

目的:观察超声引导下髂筋膜间隙阻滞(FICB)复合喉罩全身麻醉在老年股骨粗隆间骨折(FIF)手术患者中的应用效果。方法:选取90例老年FIF手术患者为研究对象,按照随机数字表法分为观察组和对照组各45例。对照组实施喉罩全身麻醉,观察组实施FICB复合喉罩全身麻醉,比较麻醉前(T_(0))、切皮时(T_(1))、手术30 min(T_(2))、手术结束时(T_(3))两组血流动力学指标[心率(HR)、平均动脉压(MAP)、收缩压(SBP)]水平、皮质醇(Cor)水平、血糖(GLU)水平,瑞芬太尼总用量、丙泊酚总用量和术后恢复情况(苏醒时间、拔除喉罩时间),术后2、6、12、24 h疼痛程度,以及不良反应发生率。结果:观察组T_(1)、T_(2)时HR、MAP、SBP水平均低于对照组,差异有统计学意义(P<0.05);两组T_(3)时HR、MAP、SBP水平比较,差异均无统计学意义(P>0.05);观察组T_(1)、T_(2)、T_(3)时Cor、GLU水平均低于对照组,差异有统计学意义(P<0.05);观察组瑞芬太尼总用量、丙泊酚总用量均低于对照组,术后苏醒时间和拔除喉罩时间均短于对照组,差异有统计学意义(P<0.05);观察组术后2、6、12、24 h视觉模拟评分法评分均低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为8.89%,低于对照组的37.78%,差异有统计学意义(P<0.05)。结论:FICB复合喉罩全身麻醉应用于老年FIF手术患者,可降低血流动力学指标水平、术后疼痛评分和不良反应发生率,减少瑞芬太尼总用量和丙泊酚总用量,缩短术后苏醒时间和拔除喉罩时间,效果优于单纯喉罩全身麻醉。

Objective:To observe application effects of ultrasound-guided fascia iliaca compartment block(FICB)combined with laryngeal mask general anesthesia in elderly patients with femoral intertrochanteric fracture(FIF)surgeries.Methods:90 elderly patients with FIF surgeries were selected as the research objects and were divided into observation group and control group according to the random number table method,45 cases in each.The control group received laryngeal mask general anesthesia,while the observation group was given FICB combined with laryngeal mask general anesthesia.The hemodynamic index levels[heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP)],the cortisol(Cor)level,the blood glucose(GLU)level,the total amount of Remifentanil and the total amount of Propofol before anesthesia(T_(0)),during skin incision(T_(1)),30 minutes after surgery(T_(2))and at the end of surgery(T_(3)),the postoperative recovery(awakening time,laryngeal mask removal time),postoperative 2,6,12,24 h pain degrees,and the incidence of adverse reactions were compared between the two groups.Results:The HR,MAP and SBP levels at T_(1) and T_(2) in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the HR,MAP and SBP levels between the two groups at T_(3)(P>0.05).The levels of Cor and GLU at T_(1),T_(2) and T_(3) in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The total amount of Remifentanil and total amount of Propofol in the observation group were lower than those in the control group;the postoperative awakening time and laryngeal mask removal time were shorter than those in the control group;and the differences were statistically significant(P<0.05).The visual analog scale scores of the observation group were lower than those of the control group 2,6,12,and 24 h after the surgery,and the differences were statistically significant(P<0.05).Further,the incidence of adverse reactions in the observation group was 8.89%,which was lower than 37.78%in the control group,and the difference was statistically significant(P<0.05).Conclusions:FICB combined with laryngeal mask general anesthesia applied to the elderly patients with FIF surgeries can reduce the hemodynamic index levels,the total amount of Fentanyl,the total amount of Propofol,the postoperative pain score and the incidence of adverse reactions,shorten the postoperative awakening time and laryngeal mask removal time.Moreover,it is superior to single laryngeal mask general anesthesia.