超声引导下腰丛-坐骨神经阻滞在股骨颈骨折中的应用效果

Application Effect of Ultrasound-guided Lumbar Plexus-sciatic Nerve Block in Femoral Neck Fracture

目的 探讨超声引导下腰丛-坐骨神经阻滞在股骨颈骨折中的应用效果及对应激反应的影响。方法 选取延安大学附属医院股骨颈骨折患者106例,使用随机数表法将其分为观察组(n=53)及对照组(n=53)。对照组接受全身麻醉,观察组接受超声引导下腰丛-坐骨神经阻滞,对比两组的麻醉、血流动力学指标、应激反应指标及不良反应发生率。结果 观察组的定向力恢复时间及麻醉起效时间均短于对照组(P<0.05)。麻醉前(T_(0)),两组患者的收缩压(SBP)、舒张压(DBP)及心率(HR)水平相较差异不显著(P>0.05);切皮时(T_(1))、手术进行30min(T_(2))、结束时(T_(3))及术后1h(T_(4))四个时间点观察组的SBP、DBP及HR水平均高于对照组(P<0.05),且全程观察组的指标波动幅度小于对照组。术前,两组去甲肾上腺素(NE)、皮质醇(Cor)、醛固酮(ALD)及血浆肾素活性(PRA)水平差异不显著(P>0.05);术后,两组各项指标均升高,但观察组低于对照组(P<0.05)。观察组不良反应发生率为3.77%低于对照组15.09%(P<0.05)。结论 超声引导下腰丛-坐骨神经阻滞在股骨颈骨折患者术中应用效果显著,可促进血流动力学水平稳定,减轻应激反应,减少术后不良反应的发生。

Objective To investigate the effect of ultrasound-guided lumbar plexus-sciatic nerve block in femoral neck fracture and its effect on stress response.Methods A total of 106 patients with femoral neck fracture in the Affiliated Hospital of Yan'an University between January 2020 and January 2021 were selected and divided into observation group(n=53)and control group(n=53)by random number table method.The control group received general anaesthesia,and the observation group received ultrasound-guided lumbar plexus-sciatic nerve block.The anaesthesia,haemodynamic indexes,stress indexes and the incidence of adverse reactions were compared between the two groups.Results The recovery time of orientation force and the onset time of anesthesia in the observation group were shorter than those in the control group(P<0.05).Before anaesthesia(T 0),the systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)levels of the two groups were not significantly different(P>0.05);the SBP,DBP and HR levels of the observation group were higher than those of the control group at four time points:at the time of skin incision(T 1),30 min during the operation(T 2),at the end of the operation(T 3)and 1 h after the operation(T 4)(P<0.05),and the fluctuation range of the indexes in the observation group was smaller than that in the control group throughout the whole period.Preoperatively,the levels of norepinephrine(NE),cortisol(Cor),aldosterone(ALD)and plasma renin activity(PRA)were not significantly different between the two groups(P>0.05);postoperatively,all indicators increased in both groups,but the observation group was lower than the control group(P<0.05).The incidence of adverse reactions in the observation group(3.77%)was lower than that in the control group(15.09%)(P<0.05).Conclusion Ultrasound-guided lumbar plexus-sciatic nerve block has a significant effect in the operation of patients with femoral neck fractures,which can promote hemodynamic stability,reduce stress response,and decrease the occurrence of postoperative adverse reactions.