LPSB及CSEA用于老年髋部骨折术的麻醉效果分析

Analysis of Anesthesia Effects of LPSB and CSEA in Elderly Hip Fracture Surgery PAN Yongyi

目的分析腰丛-坐骨神经阻滞(lumbar plexus combined with sciatic nerve block,LPSB)及腰麻-硬膜外联合麻醉(combined spinal and epidural anesthesia,CSEA)用于老年髋部骨折术的麻醉效果及对患者血流动力学的影响。方法选取2022年3月—2023年3月盐城市第一人民医院收治的60例接受髋部骨折术的老年患者作为本研究的样本对象。依据随机数字表法分组,30例纳入CSEA组,30例纳入LPSB组。记录两组患者血流动力学指标、免疫指标、麻醉时间、输液量及手术总时间、术后并发症发生率。结果T0阶段,两组患者的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)指标比较,差异无统计学意义(P>0.05);LPSB组患者在T1、T2阶段的SBP略高于CSEA组,但差异无统计学意义(P>0.05);LPSB组患者在T1、T2阶段的DBP高于CSEA组,差异有统计学意义(P<0.05);与CSEA组比较,LPSB组患者术后6 h及术后72 h的免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白E(immunoglobulin E,IgE)指标更高;此外,LPSB组患者输液量、术后并发症总发生率更低,其麻醉时间更长,差异有统计学意义(P<0.05),而二者的手术总时间比较,差异无统计学意义(P>0.05)。结论相较于CSEA,采取LPSB对接受髋部骨折术的老年患者进行麻醉能够降低对患者免疫功能等方面的影响,同时延长其麻醉时间。其对血流动力学指标影响略高于CSEA,但整体安全性较高。

Objective To analyze the anesthesia effect of lumbar plexus combined with sciatic nerve block(LPSB)and combined spinal and epidural anesthesia(CSEA)in elderly hip fracture surgery and their effect on hemodynamics.Methods A total of 60 elderly patients with hip fracture surgery treated in Yancheng NO.1 People's Hospital from March 2022 to March 2023 were selected as the sample objects of this study.According to random number table method,30 cases were included in CSEA group and 30 cases were included in LPSB group.The hemodynamic indexes,immune indexes,anesthesia time,infusion volume and total operation time,and postoperative complication rate of the two groups were recorded.Results In the T0 stage,the indexes of systolic blood pressure(SBP)and diastolic blood pressure(DBP)between the two groups did not show significant differences(P>0.05).The SBP of LPSB group was slightly higher than that of CSEA group at T1 and T2 stages,but the difference was not statistically significant(P>0.05).DBP in LPSB group was higher than that in CSEA group at T1 and T2 stages,and the difference was statistically significant(P<0.05).Compared with the CSEA group,immunoglobulin G(IgG)and immunoglobulin E(IgE)indexes in the LPSB group were higher at 6 h and 72 h after surgery;in addition,the infusion volume and the total incidence of postoperative complications were lower in the LPSB group,and the anesthesia time was longer,the difference was statistically significant(P<0.05),while there was no statistically significant difference in the total operation time between the two groups(P>0.05).Conclusion Compared with CSEA,the anesthesia of LPSB for elderly patients undergoing hip fracture surgery can reduce the impact on the immune function of patients and prolong the anesthesia time.Its effect on hemodynamic indexes was slightly higher than that of CSEA,but the overall safety was higher.