腰丛-坐骨神经阻滞与全身麻醉在老年股骨颈骨折手术治疗中的镇静效果比较

Comparison of sedative effects of lumbar plexus-sciatic nerve block and general anesthesia in the surgical treatment of femoral neck fracture in the elderly

目的 比较腰丛-坐骨神经阻滞与全身麻醉在老年股骨颈骨折手术治疗中的镇静效果。方法 选取我院2019年1月至2020年12月收治的60例老年股骨颈骨折手术患者,以手术麻醉差异将其分为全麻组(30例,全身麻醉)和局麻组(30例,腰丛-坐骨神经阻滞)。比较两组的干预效果。结果 麻醉10 min后、切片时及术后5 min,两组的心率低于麻醉前,但局麻组高于全麻组(P<0.05);麻醉10 min后、切片时,两组的体温、呼吸频率低于麻醉前,但局麻组高于全麻组(P<0.05);术后5 min,全麻组的体温、呼吸频率低于麻醉前,但局麻组高于全麻组(P<0.05);麻醉10 min后,两组的平均动脉压(MAP)低于麻醉前,但局麻组高于全麻组(P<0.05);切片时、术后5 min,全麻组的MAP低于麻醉前,但局麻组高于全麻组(P<0.05)。局麻组的腰丛神经、坐骨神经的感觉及运动神经阻滞持续时间均显著长于全麻组(P<0.05)。局麻组的术中麻醉优良率显著高于全麻组(P<0.05)。局麻组的麻醉苏醒期并发症总发生率显著低于全麻组(P<0.05)。手术后,两组的去甲肾上腺素(NE)、前列腺素E2(PGE2)、皮质醇(Cor)、D-二聚体(D-D)、组织性纤溶酶原激活物(t-PA)水平均显著高于手术前,但局麻组显著低于全麻组(P<0.05)。结论 腰丛-坐骨神经阻滞较全身麻醉在老年股骨颈骨折手术治疗中的应用效果更佳。

Objective To compare the sedative effects of lumbar plexus-sciatic nerve block and general anesthesia in the surgical treatment of femoral neck fracture in the elderly. Methods A total of 60 elderly patients undergoing femoral neck fracture surgery in our hospital from January 2019 to December 2020 were selected and divided into general anesthesia group(30 cases, general anesthesia) and local anesthesia group(30 cases, lumbar plexus-sciatic nerve block)according to the difference in surgical anesthesia. The itervention effects of the two groups were compared. Results At 10min after anesthesia, during section and at 5 min after operation, the heart rate of the two groups was lower than that before anesthesia, but that of the local anesthesia group was higher than the general anesthesia group(P<0.05);at 10 min after anesthesia and during section, the body temperature and respiratory rate of the two groups were lower than those before anesthesia, but those of the local anesthesia group were higher than the general anesthesia group(P<0.05);at 5 min after operation, the body temperature and respiratory rate in the general anesthesia group were lower than those before anesthesia,but those in the local anesthesia group were higher than the general anesthesia group(P<0.05);at 10 min after anesthesia, the mean arterial pressure(MAP) of the two groups was lower than that before anesthesia, but that of the local anesthesia group was higher than the general anesthesia group(P<0.05);during section and at 5 min after operation, the MAP in the general anesthesia group was lower than that before anesthesia, but that in the local anesthesia group was higher than the general anesthesia group(P<0.05). The duration of sensory and motor nerve block of lumbar plexus and sciatic nerve in the local anesthesia group were significantly longer than those in the general anesthesia group(P<0.05). The excellent and good rate of anesthesia during surgery in the local anesthesia group was significantly higher than that in the general anesthesia group(P<0.05). The total incidence of complications in the local anesthesia group during the awakening period of anesthesia was significantly lower than that in the general anesthesia group(P <0.05). After surgery, the levels of norepinephrine(NE),prostaglandin E2(PGE2), cortisol(Cor), D-Dimer(D-D) and tissue-plasminogen activator(t-PA) in the two groups were significantly higher than those before surgery, but those in the local anesthesia group were significantly lower than the general anesthesia group(P<0.05). Conclusion Lumbar plexus-sciatic nerve block is more effective than general anesthesia in the surgical treatment of femoral neck fracture in the elderly.