两种麻醉方式用于高龄髋部骨折手术的效果比较

Comparison of effect of two anesthesia methods for hip fracture surgery in the senile patients

目的比较腹股沟韧带上髂筋膜间隙联合骶丛神经阻滞与腰硬联合麻醉用于高龄髋部骨折手术的效果。方法将60例行髋部骨折内固定术的患者根据随机数字表法分为腹股沟韧带上髂筋膜间隙联合骶丛神经阻滞组(A组,30例)和腰硬联合麻醉组(B组,30例)。记录两组手术时间、术中出血量、复方林格液输注量,镇静药物(右美托咪定)用量、血管活性药物(麻黄碱)应用率、镇痛补救情况、各时间点疼痛VAS评分及不良事件发生情况。结果与B组比较,A组复方林格液输注量减少,麻黄碱应用率降低,右美托咪定用量增加,差异均有统计学意义(P<0.05)。术后12、24 h疼痛VAS评分A组均低于B组(P<0.05)。两组手术时间、术中出血量、镇痛补救率及不良事件发生率比较差异均无统计学意义(P>0.05)。结论与腰硬联合麻醉相比,腹股沟韧带上髂筋膜间隙联合骶丛神经阻滞能满足高龄患者髋部骨折手术麻醉需要,可稳定血流动力学,并提供有效的术后镇痛。

Objective To compare the effect of supra-inguinal fascia iliaca compartment block combined with sacral plexus block and combined spinal-epidural anesthesia for hip fracture surgery in the senile patients.Methods Sixty patients undergoing internal fixation of hip fracture were divided into supra-inguinal fascia iliaca compartment block combined with sacral plexus block group(Group A,n=30)and combined spinal-epidural anesthesia group(Group B,n=30),according to the random number table.The surgery time,intraoperative bleeding volume,fluid infusion volume of compound Ringer′s solution,sedative drugs dosage of dexmedetomidine,vasoactive drugs application rate of ephedrine,rescue analgesia,pain visual analogue scale(VAS)at various time-point,and the incidence of adverse events were recorded in the two groups.Results Compared with Group B,the fluid infusion volume of compound Ringer′s solution and application rate of ephedrine were decreased and dosage of dexmedetomidine were increased in Group A,there were statistical differences(P<0.05).At 12,24 h postoperation,the pain VAS were lower in Group A than Group B(P<0.05).There were no differences between the two groups in terms of operation time,the intraoperative bleeding volume,the rate of rescue analgesia and the incidence rate of adverse events(P>0.05).Conclusions Compared with combined spinal-epidural anesthesia,supra-inguinal fascia iliaca compartment block combined with sacral plexus block can meet the anaesthetic need for hip fracture in senile patients,which can maintain hemodynamics stable and provide postoperative analgesic effect.