仰卧位腰大肌短轴复合右美托咪定腰丛神经阻滞的麻醉效果评估

Evaluation of the anesthesia effect of the short axis of the psoas major in the supine position combined with dexmedetomidine lumbar plexus block

目的探讨仰卧位腰大肌短轴复合右美托咪定腰丛神经阻滞在老年股骨近端内固定术中的麻醉效果。方法本研究为前瞻性研究,选取2018年6月—2020年6月河北工程大学附属医院收治的120例单侧股骨粗隆间骨折的老年患者,根据随机数字表法分为对照组和观察组,每组60例。对照组采用腰硬联合麻醉,观察组采用仰卧位腰大肌短轴复合右美托咪定腰丛神经阻滞。比较两组患者术后1、3、6、12、24 h的视觉模拟评分(VAS)、Ramsay评分,以及血流动力学状态、不良反应情况。结果两组患者术后1、3 h的VAS评分差异无统计学意义(P>0.05),观察组术后6、12、24 h的VAS评分明显低于对照组(P<0.05)。两组患者术后各时间点的Ramsay评分差异无统计学意义(P>0.05)。观察组患者仰卧位时的HR、MAP低于对照组,而麻醉10 min至手术完成期间的HR、MAP高于对照组,观察组的HR、MAP波动幅度低于对照组,差异有统计学意义(P<0.05)。不良反应主要为低血压、心动过缓、镇痛不足以及恶心呕吐,其中两组不良反应率差异无统计学意义(P<0.05)。结论仰卧位腰大肌短轴复合右美托咪定腰丛神经阻滞对于老年股骨近端内固定术具有良好的麻醉、镇静效果,可延长作用时间,稳定血流动力学状态,安全性较好。

Objective To study the anesthesia effect of the short axis of the psoas major in the supine position combined with dexmedetomidine lumbar plexus block in the elderly proximal femur internal fixation.Methods This study was a prospective study.120 elderly patients with unilateral femoral intertrochanteric fractures admitted in our hospital from June 2018 to June 2020 were selected and divided into a control group and an observation group according to the random number table method,with 60 cases in each group.The control group was treated with combined spinal-epidural anesthesia,and the observation group was treated with the short axis of the psoas major in the supine position combined with dexmedetomidine lumbar plexus block.The visual analogue score(VAS),Ramsay score,hemodynamic status,and adverse reactions were compared between the two groups of patients at 1 h,3 h,6 h,12 h,and 24 h after surgery.Results There were no significant difference in VAS scores between the two groups of patients at 1h and 3h after surgery.The VAS scores of the observation group at 6h,12h,and 24h after surgery were significantly lower than those of the control group(P<0.05).There was no significant difference in Ramsay scores between the two groups of patients at various time points after surgery(P>0.05).The HR and MAP of patients in the observation group in the supine position were lower than those in the control group,while the HR and MAP from 10 minutes of anesthesia to the completion of operation were higher than those in the control group.The fluctuation range of HR and MAP in the observation group was lower than that in the control group(P<0.05).The main adverse reactions were hypotension,bradycardia,insufficient analgesia and nausea and vomiting.There was no significant difference between the two groups(P<0.05).Conclusion Psoas major short axis combined with dexmedetomidine lumbar plexus block in supine position has good anesthetic and sedative effects for proximal femoral fixation in the elderly,can prolong the action time,stabilize the hemodynamic state,and has good safety.