老年股骨颈骨折手术患者全身麻醉联合股外侧皮神经阻滞的效果观察

Observation on the effect of general anesthesia combined with lateral femoral cutaneous nerve block in elderly patients undergoing femoral neck fracture surgery

目的分析老年股骨颈骨折(femoral neck fracture,FNF)手术患者应用全身麻醉联合股外侧皮神经阻滞的效果。方法选取2020年7月—2022年7月温州市人民医院收治的60例老年FNF手术患者。回顾性分析患者资料,按不同麻醉方式分为对照组(30例)行全身麻醉、研究组(30例)行全麻联合股外侧皮神经阻滞,比较两组疼痛程度、生命体征、术后苏醒情况、认知功能。结果研究组术后1 h、术后2 h、术后1 d及术后2 d的VAS评分、去甲肾上腺素(NE)水平均显著低于对照组(P<0.05)。相较对照组,切皮时(T1)、骨膜剥离时(T2)、术毕(T3)及拔出喉罩时(T4),患者心率(HR)、平均动脉压(MAP)水平降低;拔管时间、麻醉苏醒及胃肠蠕动恢复时间均较对照组更短(P<0.05)。研究组术后1 d、术后2 d及术后3 d简易智力状态检查量表(MMSE)评分则显著高于对照组(P<0.05)。结论老年FNF手术患者应用全身麻醉联合股外侧皮神经阻滞,可能有利于减轻患者疼痛程度、维持生命体征稳定,且对患者认知功能影响较小。

Objective To analyze the effect of general anesthesia combined with lateral femoral nerve block in elderly patients with femoral neck fracture(FNF).Method 60 elderly patients with FNF admitted to Wenzhou People's Hospital from July 2020 to July 2022 were selected.The data of the patients were retrospectively analyzed and the patients were divided into different groups according to different anesthesia methods.The control group(30 cases)received general anesthesia,and the study group(30 cases)received general anesthesia combined with lateral femoral cutaneous nerve block.The pain degree,vital signs,postoperative recovery and cognitive function between the two groups were compared.Result VAS scores and the level of NE in the study group were lower than those in the control group at 1 h,2 h,1 d and 2d after operation(P<0.05);The levels of HR and MAP at T1,T2,T3 and T4 in the study group were lower than those in the control group(P<0.05);The extubation time,anesthesia recovery time and gastrointestinal peristalsis recovery time of the study group were shorter than those of the control group(P<0.05);The MMSE scores of the study group were higher than those of the control group on the first day,the second day and the third day after operation(P<0.05).Conclusion The use of general anesthesia combined with lateral femoral cutaneous nerve block in elderly patients with FNF surgery may be beneficial to reduce pain and maintain the stability of vital signs,and has little impact on cognitive function of patients.