股神经联合股外侧皮神经阻滞麻醉应用于高龄和危重症股骨骨折患者手术中的效果观察

Observation on Effect of Combined Femoral Nerve and Lateral Femoral Cutaneous Nerve Block for Femoral Fracture Surgery Anesthesia of Elderly and Critically Ill Patients

目的:探讨股神经联合股外侧皮神经阻滞麻醉应用于高龄和危重症股骨骨折患者手术中的效果。方法:选取2019年1月-2022年10月威海市立第三医院收治的60例高龄危重症股骨骨折患者作为研究对象,按照随机数字表法分为对照组与观察组,各30例。对照组实施腰硬联合麻醉,观察组实施股神经联合股外侧皮神经阻滞麻醉。比较两组麻醉优良率、生命体征指标、神经阻滞起效与持续时间、麻醉不良反应发生情况。结果:两组麻醉优良率比较,差异无统计学意义(P>0.05);两组切皮前后的平均动脉压、中心静脉压、呼吸频率、血氧饱和度、心率比较,差异无统计学意义(P>0.05)。观察组感觉神经阻滞持续时间、运动神经阻滞起效、持续时间均长于对照组,差异有统计学意义(P<0.001)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:股神经联合股外侧皮神经阻滞麻醉用于高龄危重症股骨骨折患者手术中,能稳定术中各项生命体征,延长神经阻滞时间,有利于提升术后镇痛作用和减少麻醉不良反应,安全性良好。

Objective:To investigate the effect of combined femoral nerve and lateral femoral cutaneous nerve block in femoral fracture surgery anesthesia for elderly and critically ill patients.Methods:From January 2019 to October 2022,60 elderly patients with critical femoral fractures in Weihai Municipal Third Hospital were selected as study subjects,and they were divided into control group and observation group according to random number table method,with 30 cases in each group.The control group was given combined spinal-epidural anesthesia,while the observation group was given combined femoral nerve and lateral femoral cutaneous nerve block anesthesia.The excellent and good anesthesia rate,vital sign indexes,block onset time,block duration,and anesthesia adverse reactions were compared between the two groups.Results:There was no significant difference between two groups in excellent and good rates of anesthesia(P>0.05).There was no significant difference in mean arterial pressure,central venous pressure,respiratory rate,blood oxygen saturation and heart rate in the two groups before and after skin cutting(P>0.05).The durations of sensory nerve block and motor nerve block in observation group were longer than those in control group,and the difference was statistically significant(P=0.001).There was no significant difference between two groups in the incidence of adverse reactions(P<0.05).Conclusion:Combined femoral nerve and lateral femoral cutaneous nerve block in surgery anesthesia for elderly patients with critical femoral fracture can stabilize vital signs during operation,prolong the nerve block duration,improve postoperative analgesia and reduce the adverse reaction of anesthesia,with good safety.