腰硬联合麻醉与全身麻醉应用于股骨颈骨折手术的临床麻醉效果比较

Comparison of Clinical Anesthetic Effect Between Combined Lumbar Epidural Anesthesia and General Anesthesia in Operation of Femoral Neck Fracture

对比腰硬联合麻醉与全身麻醉应用于股骨颈骨折手术的临床麻醉效果。方法:以我院2018年10月-2021年10月收治的240例股骨颈骨折患者为研究对象,采用随机数字表法平均分为腰硬组(观察组)与全麻组(对照组),各120例。对比2组患者麻醉前、麻醉后0.5小时、1小时、手术结束时血压和心率的变化,麻醉相关指标数据(麻醉生效、意识恢复、镇痛维持时间),术后2小时、12小时、24小时、48小时疼痛视觉模拟评分(VAS)得分情况,麻醉前、麻醉后1天、3天简易智力状态检查量表(MMSE)评分以及血清神经元特异性烯醇化酶(NSE)、S100B蛋白、β-淀粉样蛋白(Aβ)水平,术后不良反应发生情况(恶心呕吐、肺部感染、缺氧、躁动、头晕嗜睡)。结果:观察组患者前后血压波动不大(P>0.05),心率仅在麻醉后0.5小时与麻醉前有较大的差别(P<0.05),麻醉后1小时与手术结束时与麻醉前相比变化幅度不大(P>0.05)。对照组血压和心率麻醉前与麻醉后各时段差别均较大(P<0.05);观察组患者麻醉生效、意识恢复时间分别为(6.37±3.12)分钟、(7.93±1.65)分钟,短于对照组的(7.24±2.97)分钟、(11.37±2.37)分钟(P<0.05);镇痛维持时间为(179.62±13.46)分钟,较对照组的(165.64±13.62)分钟时间长(P<0.05);观察组患者术后2小时、12小时、24小时、48小时的VAS得分均低于对照组(P<0.05);观察组患者麻醉后1天、3天MMSE评分均高于对照组(P<0.05);观察组患者麻醉后1天、3天的NSE、S100 B蛋白、Aβ水平均低于对照组(P<0.05);术后不良反应发生率为8.33%,低于对照组的25.00%(P<0.05)。结论:研究发现,腰硬联合麻醉应用于股骨颈骨折手术的麻醉效果较全身麻醉更具有优势,能够稳定患者的心血管系统,对患者的神经功能和认知功能有相对较好的保护作用,并且安全性相对较高,值得临床推广使用。

Objective:Contrast waist hard joint anesthesia and general anesthesia used in clinical anesthesia effect of femoral neck fracture surgery.Methods:In October 2018 to October 2021 in our hospital during the period of 240 patients with femoral neck fracture were treated as the research object,indicator method using randomly divided into the waist hard and anesthesia group,120 cases each.The changes of blood pressure and heart rate,data of anesthesia related indicators(effective anesthesia,recovery of consciousness,duration of analgesia),visual analog scale(VAS)scores at 2h,12h,24h and 48h after surgery were compared between the two groups.Before anesthesia,1d and 3D after anesthesia,simple Mental state Examination Scale(MMSE)score,serum neuron specific enolase(NSE),S10OB protein,β-amyloid protein(Aβ)level,postoperative adverse reactions(nausea and vomiting,pulmonary infection,hypoxia,agitation,dizziness and somnia).Results:There was no significant change in blood pressure before and after anesthesia(P>0.05)in lumbar spine group,and significant diference in heart rate between 0.5h after anesthesia and before anesthesia(P<0.05).There was no significant difference in blood pressure and heart rate between 1h after anesthesia and at the end of surgery(P>0.05),but significant difference in blood pressure and heart rate before and after anesthesia in general anesthesia group(P<0.05).Waist hard patients anesthesia effect,consciousness recovery time(6.37±3.12)min,respectively(7.93±1.65)min,shorter than general anesthesia group(7.24±2.97)min and(11.37±2.37)min(P<0.05),analgesia maintaining time is(179.62±13.46)min,Compared with general anesthesia group(179.62±13.46)min longer(P<0.05);VAS scores at 2h,12h,24h and 48h after operation in patients with lumbar stiffness group were lower than those in general anesthesia group(P<0.05).MMSE scores of patients in lumbar epidural group were higher than those in general anesthesia group at ld and 3d after anesthesia(P<0.05).The levels of NSE,S100B protein and Aβin lumbar epidural group were lower than those in general anesthesia group at ld and 3d after anesthesia(P<0.05).The incidence of postoperative adverse reactions(8.33%)was lower than that of general anesthesia group(25.00%)(P<0.05).Conclusion:Studies have found that combined lumbar and epidural anesthesia has more advantages than general anesthesia in the anesthesia effect of femoral neck fracture surgery,which can stabilize the cardiovascular system of patients,and has a relatively good protective effect on patients'neurological function and cognitive function with relatively high safety,which is worthy of clinical application.