髂筋膜-骶丛神经阻滞对老年股骨近端骨折患者的镇痛效果及应激反应的影响

Effect of Iliac Fascia Sacral Plexus Block on Analgesia and Stress Response in Elderly Patients with Proximal Femoral Fractures

目的:探讨髂筋膜-骶丛神经阻滞对老年股骨近端骨折患者的镇痛效果及应激反应的影响。方法:选取2020年6月-2022年6月在茂名市人民医院骨科行手术治疗的120例老年股骨近端骨折患者为研究对象,按照抽签法将其随机分为研究组和参照组,各60例。参照组给予单侧蛛网膜下腔麻醉,研究组给予髂筋膜-骶丛神经阻滞,比较两组麻醉阻滞时间及不同时间点疼痛程度、应激反应的变化。结果:与参照组比,研究组感觉、运动阻滞起效及完全时间均更长,差异有统计学意义(P<0.05)。研究组术后24 h时VAS评分低于参照组,而手术切皮时、手术结束时VAS评分高于参照组,差异有统计学意义(P<0.05)。术后12、24 h时,研究组血清皮质醇、血管紧张素Ⅱ水平均低于参照组,差异有统计学意义(P<0.05)。结论:将髂筋膜-骶丛神经阻滞应用于老年股骨近端骨折手术中,可显著延长麻醉阻滞时间,提高镇痛效果,并有助于减轻机体应激反应。

Objective:To explore the effect of iliac fascia sacral plexus block on analgesia and stress response in elderly patients with proximal femoral fractures.Method:A total of 120 elderly patients with proximal femoral fracture who received surgical treatment in the Orthopedics Department of Maoming People’s Hospital from June 2020 to June 2022 were selected as the research objects.According to the lottery method,they were randomly divided into the study group and the reference group,with 60 cases in each group.The reference group was given unilateral subarachnoid anesthesia,and the study group was given iliac fascia sacral plexus block.The duration of anesthesia block and the changes of pain degree and stress response at different time points were compared between the two groups.Result:Compared with the reference group,the onset and complete time of sensory and motor block in the study group were longer,and the differences were statistically significant(P<0.05).The VAS score of the study group at 24 h after surgery was lower than that of the reference group,but the VAS score at the time of operation and the end of operation were higher than those of the reference group,the differences were statistically significant(P<0.05).At 12,24 h after operation,the levels of serum cortisol and angiotensinⅡin the study group were lower than those in the reference group,the differences were statistically significant(P<0.05).Conclusion:The application of iliac fascia sacral plexus block in the operation of femoral proximal fracture in the elderly can significantly prolong the anesthesia block time,improve the analgesic effect,and help to reduce the stress response of the body.