腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉在高龄股骨粗隆间骨折手术中的应用

Application of lumbar plexus combined with sciatic nerve block combined with low-dose propofol anesthesia in elderly patients with intertrochanteric fractures

目的 探讨腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉在高龄股骨粗隆间骨折手术中的效果与应用价值。方法 选取2019年6月至2020年10月于本院接受手术治疗的50例股骨粗隆间骨折老年患者作为研究对象,随机分为两组,每组25例。对照组予以静脉全身麻醉,观察组予以腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉,比较两组麻醉前后不同时间心率、平均动脉压变化,比较两组临床指标及麻醉前与手术后警觉/镇静(OAA/S)评分。结果 麻醉前、拔除喉罩5 min后,两组心率、平均动脉压水平比较差异无统计学意义;麻醉5、30、45 min后,观察组心率、平均动脉压水平均明显高于对照组(P<0.05)。观察组阿托品用量明显低于对照组,术后患者恢复清醒时间、进食时间均明显短于对照组,疼痛恢复时间长于对照组(P<0.05)。两组术前OAA/S评分比较差异无统计学意义;术后,观察组OAA/S评分高于对照组(P<0.05)。结论 股骨粗隆间骨折老年患者手术治疗前选择腰丛联合坐骨神经阻滞复合小剂量丙泊酚麻醉方案效果确切,能减少药物用量,减轻患者痛苦,值得临床应用推广。

Objective To investigate the effect and application value of lumbar plexus combined sciatic nerve block combined with low-dose propofol anesthesia in elderly patients with intertrochanteric fracture of femur. Methods A total of 50 elderly patients with intertrochanteric fracture of femur who received surgical treatment in our hospital from June 2019 to October 2020 were selected as the study subjects and randomly divided into two groups, with 25 cases in each group. The control group was given intravenous general anesthesia, and the observation group was given lumbar plexus combined with sciatic nerve block combined with low-dose propofol anesthesia. The changes of heart rate and mean arterial pressure at different time before and after anesthesia were compared between the two groups. The clinical indicators and observers assessment of alertness/sedation scale(OAA/S) scores before and after anesthesia were compared between the two groups. Results There were no significant differences in heart rate and mean arterial pressure between the two groups before anesthesia and 5 min after laryngeal mask removal. After 5, 30 and 45 minutes of anesthesia, heart rate and mean arterial pressure in observation group were significantly higher than those in control group(P<0.05). The amount of atropine in the observation group was significantly lower than that in the control group, the postoperative recovery time and eating time in the observation group were significantly shorter than those in the control group, and pain recovery time was longer than that in the control group(P<0.05).Before surgery, there was no significant difference in OAA/S score between two groups;after surgery, OAA/S score in the observation group was higher than that in the control group(P<0.05). Conclusion Lumbar plexus combined with sciatic nerve block combined with low-dose propofol anesthesia is effective in elderly patients with intertrochanteric fracture of femur, which can reduce drug dosage and relieve pain, it is worthy of clinical application and promotion.