超声下腹股沟韧带上髂筋膜阻滞对股骨粗隆间骨折患者血流动力学的影响

Effect of ultrasonic iliac fascia block on the inguinal ligament on hemodynamics in patients with intertrochanteric fracture

目的分析超声下腹股沟韧带上髂筋膜阻滞对股骨粗隆间骨折患者血流动力学的影响。方法回顾性分析2021年7月至2022年8月九江市第三人民医院收治的60例股骨粗隆间骨折患者临床资料,根据麻醉方法的不同将其分为参照组(气管插管静脉复合麻醉,30例)与研究组(超声下腹股沟韧带上髂筋膜阻滞,30例)。比较两组术后2 h疼痛视觉模拟评分法(VAS)评分、拔管时间、麻醉苏醒时间、丙泊酚用量、瑞芬太尼用量和围麻醉期血流动力学指标、血浆血管紧张素、血浆肾素活性及醛固酮。结果研究组术后2 h的VAS评分低于参照组,拔管时间、麻醉苏醒时间短于参照组,丙泊酚用量、瑞芬太尼用量少于参照组,差异有统计学意义(P<0.05)。研究组麻醉后5 min的心率高于参照组,麻醉后30 min、麻醉结束时的心率低于参照组,差异有统计学意义(P<0.05);研究组麻醉后5 min、麻醉结束时的收缩压高于参照组,麻醉后30 min的收缩压低于参照组,差异有统计学意义(P<0.05)。麻醉后5 min、麻醉结束时,研究组血浆血管紧张素Ⅱ、血浆肾素活性、醛固酮水平低于参照组,差异有统计学意义(P<0.05)。结论在股骨粗隆间骨折手术中采用超声下腹股沟韧带上髂筋膜阻滞对患者血流动力学影响较小,还能缩短拔管时间、麻醉苏醒时间,镇痛效果显著,减少麻醉用药。

Objective To analyze the effect of ultrasound iliofascia block in the superior inguinal ligament on hemodynamics in patients with intertrochanteric fractures.Methods The clinical data of 60 patients with intertrochanteric fracture admitted to Jiujiang Third People's Hospital from July 2021 to August 2022 were retrospectively analyzed.According to the different anesthesia methods,they were divided into reference group(intravenous endotracheal anesthesia,30 cases)and study group(suprascinal iliac fascia block of ultrasonic inguinal ligament,30 cases).Pain visual analogue scale(VAS)score 2 h after surgery,time to extubation,awakening from anesthesia,propofol dosage,remifentanil dosage and peri-anaesthetic hemodynamic indicators,plasma angiotensin,plasma renin activity,and aldosterone were compared between the two groups.Results In the study group,the visual analog pain score was lower than the reference group,the extubation time and awakening time from anesthesia were shorter than the reference group,and the amount of propofol and remifentanyl were less than the reference group(P<0.05).At 5 min after anesthesia,the systolic blood pressure and heart rate of the study group were higher than the reference group(P<0.05);at 30 min after anesthesia,the study group was lower than the reference group(P<0.05);at the end of anesthesia,the heart rate was lower and the blood pressure was higher than the reference group(P<0.05).Plasma angiotensin,plasma renin activity and aldosterone levels in the study group were lower than those in the reference group(P<0.05).Conclusion In the operation of femoral fracture fracture,ultrasound has little influence on the hemodynamics of patients,and can shorten the extubation time and awakening time of anesthesia,with significant analgesic effect and reduce anesthetic drugs.