小剂量丙泊酚用于老年髋部骨折手术超声引导下腰骶丛神经阻滞麻醉维持的临床效果

Clinical Effect of Low-dose Propofol on the Maintenance of Lumbosacral Plexus Block Anesthesia under Ultrasound Guidance in Elderly Hip Fracture Surgery

目的:探讨小剂量丙泊酚用于老年髋部骨折手术超声引导下腰骶丛神经阻滞麻醉维持的临床效果。方法:选择2022年3月—2023年3月广东省第二中医院收治的88例老年髋部骨折手术患者作为研究对象,根据随机数表法将患者分为观察组和对照组,两组均实施超声引导下腰骶丛神经阻滞麻醉,观察组在麻醉维持期使用小剂量[0.5~1.0 mg/(kg·h)]的丙泊酚静脉泵注,对照组则使用常规剂量[1.5^(2).0 mg/(kg·h)],比较两组麻醉维持效果[麻醉起效时间、麻醉维持时间及术后2 h视觉模拟评分法(VAS)评分]、血流动力学(心率、平均动脉压及血氧饱和度)、术后认知功能、不良反应发生情况。结果:两组麻醉起效时间、麻醉维持时间及术后2 h VAS评分比较,差异无统计学意义(P>0.05)。两组手术开始30 min、手术结束时心率和平均动脉压均升高,对照组血氧饱和度升高,差异有统计学意义(P<0.05);但两组间麻醉前、手术开始30 min、手术结束时心率、平均动脉压、血氧饱和度比较,差异无统计学意义(P>0.05)。两组术前蒙特利尔认知评估量表评分、简明精神量表评分比较,差异无统计学意义(P>0.05);两组术后24 h蒙特利尔认知评估量表评分、简明精神量表评分降低,但观察组高于对照组,术后48 h蒙特利尔认知评估量表评分、简明精神量表评分又升高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,但两组比较差异无统计学意义(P>0.05)。结论:小剂量丙泊酚用于老年髋部骨折手术超声引导下腰骶丛神经阻滞麻醉维持的效果较好,与常规剂量相当,也能较好地稳定血流动力学,且更利于减少对认知功能的影响,安全性较高。

Objective:To explore the clinical effect of low-dose Propofol on the maintenance of lumbosacral plexus block anesthesia under ultrasound guidance in elderly hip fracture surgery.Method:A total of 88 elderly patients with hip fracture who treated in Guangdong Second Traditional Chinese Medicine Hospital were selected as the research subjects from March 2022 to March 2023,the patients were divided into control group and observation group according to the random number table method,44 cases in each group,two groups were given lumbosacral plexus block anesthesia under ultrasound guidance,the observation group was given intravenous infusion of low-dose Propofol[0.5-1.0 mg/(kg·h)]during anesthesia maintenance,while the control group was given conventional dose[1.5-2.0 mg/(kg·h)].The effect of anesthesia maintenance[onset time of anesthesia,maintenance time of anesthesia and visual analogue scale(VAS)score at 2 h after operation],hemodynamics(heart rate,mean arterial pressure and oxygen saturation),postoperative cognitive function and adverse reactions were compared between two groups.Result:There were no statistically significant differences in the onset time of anesthesia,maintenance time of anesthesia and VAS score at 2 h after operation between two groups(P>0.05).The heart rate and mean arterial pressure of two groups increased at 30 min after the beginning of operation and at the end of operation,and the blood oxygen saturation of the control group increased,the differences were statistically significant(P<0.05);there were no significant differences in heart rate,mean arterial pressure and blood oxygen saturation between two groups before anesthesia,30 min after operation and at the end of operation(P>0.05).There were no statistically significant differences in the scores of Montreal cognitive assessment scale and concise psychiatric scale between two groups before surgery(P>0.05);the scores of Montreal cognitive assessment scale and concise psychiatric scale decreased at 24 h after operation in both groups,but which in the observation group were higher than those in the control group,the scores of Montreal cognitive assessment scale and concise psychiatric scale increased again at 48 h after operation,and which in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,but there was no statistically significant difference between two groups(P>0.05).Conclusion:Low-dose Propofol has a good effect on the maintenance of lumbosacral plexus block anesthesia under ultrasound guidance in elderly hip fracture surgery,it is equivalent to the conventional dose and can better stabilize hemodynamics,and it is more conducive to reducing the impact on cognitive function and has higher safety.