超声引导下腰方肌阻滞联合喉罩全身麻醉在股骨颈骨折手术中的应用

Application of ultrasound-guided quadratus lumborum block combined with laryngeal mask general anesthesia in surgery for femoral neck fracture

目的探讨超声引导下腰方肌阻滞(QLB)联合喉罩全身麻醉在股骨颈骨折手术中的应用价值。方法抽取2018年4月至2020年5月焦作市中医院收治的104例股骨颈骨折患者,按随机数字表法分为对照组和观察组,每组52例。对照组采用喉罩全身麻醉进行手术,观察组采用超声引导下QLB联合喉罩全身麻醉进行手术。比较两组麻醉恢复及手术相关指标,比较两组麻醉诱导前(T0)、插管时(T1)、插管后5 min(T2)、拔管后5 min(T3)的血流动力学[平均动脉压(MAP)、心率(HR)],比较两组术后2、12、24 h的镇痛效果[视觉模拟评分法(VAS)],记录并比较两组不良事件发生情况。结果观察组麻醉苏醒、拔管、恢复室停留时间均短于对照组(P均<0.05)。T1时,两组MAP、HR低于T0时;T2、T3时,两组MAP、HR较T0时点呈升高趋势,且观察组变化幅度较小(P<0.05)。术后12、24 h时,两组VAS评分低于术后2 h,且观察组各时点VAS评分均低于对照组(P均<0.05)。观察组不良事件发生率(1.92%,1/52)与对照组(9.62%,5/52)比较差异未见统计学意义(P>0.05)。结论超声引导下QLB联合喉罩全身麻醉能够提高股骨颈骨折手术患者的苏醒质量,维持血流动力学稳定,且术后镇痛效果佳。

Objective To investigate the application value of ultrasound-guided quadratus lumborum block(QLB)combined with laryngeal mask general anesthesia in surgery for femoral neck fractures.Methods One hundred and four patients with femoral neck fractures treated in Jiaozuo Hospital of Traditional Chinese Medicine from April 2018 to May 2020 were selected,and they were divided into control group and observation group by random number table method,with 52 cases in each group.The control group underwent operation under laryngeal mask general anesthesia,and the observation group underwent operation under ultrasound-guided QLB combined with laryngeal mask general anesthesia.Anesthesia recovery and operation related indexes were compared between the two groups.Before anesthesia induction(T0),during intubation(T1),5 min after intubation(T2),5 min after extubation(T3),the hemodynamics including mean arterial pressure(MAP)and heart rate(HR)of the two groups were compared;the analgesic effects and visual analogue scale(VAS)score of the two groups were compared 2,12 and 24 h after operation.The incidences of adverse reactions were recorded and compared between the two groups.Results The anesthesia recovery time,extubation time and recovery room residence time in the observation group were shorter than those in the control group(all P<0.05).Compared with those indexes at T0,MAP and HR decreased at T1,and increased at T2 and T3 in both groups,and the change ranges of the observation group were smaller(P<0.05).Compared with those indexes 2 h after operation,the VAS scores of both groups were lower 12 h and 24 h after operation,and the VAS scores at each time point of the observation group were lower than those of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group(1.92%,1/52)and the control group(9.62%,5/52),P>0.05.Conclusions Ultrasound-guided QLB combined with laryngeal mask general anesthesia can improve the awakening quality of patients with femoral neck fractures,maintain hemodynamic stability,and has good postoperative analgesic effects.