超声引导下行神经阻滞超前镇痛对下肢骨折患者疼痛程度的影响

Effect of Ultrasound-guided Nerve Block Preemptive Analgesia on Pain in Patients with Lower Limb Fracture

目的探讨下肢骨折患者在超声引导下行神经阻滞超前镇痛对疼痛程度的影响。方法纳入2020年1月-2021年12月黄河三门峡医院96例下肢骨折患者为研究对象,进行前瞻性随机对照研究,采用随机抽签法将其分为对照组(48例)与观察组(48例),对照组采用常规全身麻醉,观察组采用超声引导下神经阻滞+全身麻醉,观察两组不同时间生命体征相关指标(心率、平均动脉压、血氧饱和度),对比两组术后6h、24h、48h时疼痛程度[视觉模拟评分法(VAS)],比较两组术前、手术结束时应激反应(血清皮质醇、去甲肾上腺素、血管紧张素Ⅱ),并观察两组麻醉苏醒期躁动情况。结果观察组不同时间心率、平均动脉压变化幅度小于对照组,两组组间、时间、组间与时点交叉比较,差异有统计学意义(P<0.05);观察组术后6h、24h、48h时VAS评分均低于对照组,差异有统计学意义(P<0.05);手术结束时,两组血清皮质醇、去甲肾上腺素、血管紧张素Ⅱ水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);观察组麻醉苏醒期躁动程度低于对照组,差异有统计学意义(P<0.05)。结论超声引导下行神经阻滞超前镇痛有助于维持下肢骨折患者术中生命体征平稳,减轻疼痛程度、应激反应及苏醒期躁动。

Objective To explore the effect of preemptive analgesia on pain degree of lower limb fracture patients under ultrasound-guided nerve block.Methods 96 patients with lower limb fractures in Yellow River Sanmenxia Hospital from January 2020 to December 2021 were included in the study.A prospective randomized controlled study was conducted.They were divided into control group(48 cases)and observation group(48 cases)by random drawing.Routine general anesthesia was used in the control group,and ultrasound-guided nerve block+general anesthesia was used in the observation group.The vital signs and related indexes(heart rate,mean arterial pressure,blood oxygen saturation)of the two groups at different times were observed.The pain degree(VAS)at 6h,24h and 48h after operation was compared between the two groups,and the stress response(serum cortisol,norepinephrine and angiotensinⅡ)before and after operation was compared between the two groups,and the agitation of the two groups during anesthesia awakening period was observed.Results The changes of heart rate and mean arterial pressure at different time points in the observation group were smaller than those in the control group.There were statistical significant differences between the two groups,time,group and time point(P<0.05).VAS scores of the observation group at 6h,24h and 48h after operation were lower than those of the control group,with a statistical significant difference(P<0.05).At the end of the operation,the levels of serum cortisol,norepinephrine and angiotensinⅡin the two groups were higher than those before the operation,but those in the observation group were lower than those in the control group,with a statistical significant difference(P<0.05).The degree of agitation in the observation group was lower than that in the control group,with a statistical significant difference(P<0.05).Conclusion Ultrasoundguided nerve block and preemptive analgesia can help to maintain the stability of vital signs of patients with lower limb fracture during operation,reduce the degree of pain,stress reaction and agitation during recovery.