超声引导下髂筋膜神经阻滞在老年股骨闭合髓内针内固定术中的应用

Application of Ultrasound-guided Iliac Fascial Nerve Block in Internal Fixation of Closed Intramedullary Pins in the Elderly Femur

目的探讨对行股骨闭合髓内针内固定的老年患者采用超声引导下髂筋膜神经阻滞的效果。方法选择2020年5月—2022年4月扬州市江都人民医院收治的行股骨闭合髓内针内固定治疗的老年患者80例,随机分为对照组(n=40,常规全麻)与观察组(n=40,联合超声引导下髂筋膜神经阻滞),比较两组术中不同时刻的平均动脉压、心率,术后2、6、12、24 h的疼痛评分(VAS)与镇静-躁动评分(RASS)。结果观察组手术开始5 min的心率为(79.59±3.40)次/min,低于对照组,平均动脉压为(94.65±3.71)mmHg,高于对照组,差异有统计学意义(t=17.966、10.189,P<0.05)。观察组术后2、6、12、24 h的VAS评分分别为(1.50±0.34)分、(2.03±0.38)分、(2.51±0.53)分、(2.93±0.89)分,均低于对照组,差异有统计学意义(t=13.535、12.713、9.481、7.231,P<0.05)。观察组术后2、6 h的RASS评分分别为(-1.30±0.30)分、(-1.13±0.28)分,均高于对照组,差异有统计学意义(t=6.586、5.699,P<0.05)。结论对老年股骨闭合髓内针固定术患者采用超声引导下髂筋膜神经阻滞能维持患者术中生命体征稳定,术后镇痛、镇静作用理想。

Objective To investigate the effect of using ultrasound-guided iliac fascia nerve block in elderly patients with closed intramedullary femoral pin internal fixation.Methods From May 2020 to April 2022,80 elderly patients treated with closed intramedullary nail fixation of femur in Yangzhou Jiangdu People´s Hospital were selected and randomly divided into control group(n=40,conventional general anesthesia)and observation group(n=40,combined with ultrasound-guided iliac fascial nerve block).The mean arterial pressure and heart rate at different times during operation,24 h pain score(VAS)and sedation-restlessness score(RASS)were compared between the two groups.Results The heart rate of the observation group was(79.59±3.40)beats/min at the beginning of the operation,which was lower than that of the control group,and the mean arterial pressure was(94.65±3.71)mmHg,which was higher than that of the control group,and the difference was statistically significant(t=17.966,10.189,P<0.05).The VAS scores of the observation group were(1.50±0.34)points,(2.03±0.38)points,(2.51±0.53)points and(2.93±0.89)points,respectively,at 2 h,6 h,12 h and 24 h after operation,which were significantly lower than those of the control group(t=13.535,12.713,9.481,7.231,P<0.05).The RASS scores of the observation group were(-1.30±0.30)points and(-1.13±0.28)points respectively at 2 h and 6 h after operation,which were higher than those of the control group,and the difference was statistically significant(t=6.586,5.699,P<0.05).Conclusion The use of ultrasound-guided iliac fascia nerve block in elderly patients undergoing closed intramedullary femoral pin fixation can maintain the stability of patients´intraoperative vital signs,and the postoperative analgesic and sedative effects are ideal.