蛛网膜下腔阻滞联合髂筋膜阻滞在老年髋部骨折患者手术中的应用效果及患者术后谵妄相关因素探讨

Application Effect of Subarachnoid Block Combined with Iliac Fascia Block in Elderly Patients with Hip Fracture Surgery and the Related Factors of Postoperative Delirium

目的探讨老年髋部骨折手术中应用蛛网膜下腔阻滞联合髂筋膜阻滞的效果及术后谵妄的相关影响因素。方法选取2021年10月至2022年12月在信阳市中心医院接受蛛网膜下腔阻滞联合髂筋膜阻滞麻醉下髋部骨折手术治疗的老年患者80例作为观察组,同时选取接受蛛网膜下腔阻滞下髋部骨折手术治疗的老年患者80例作为对照组,观察两组运动神经、感觉神经阻滞起效时间和维持时间、视觉模拟评分法(VAS)评分、术后谵妄发生情况等。结果观察组神经阻滞起效时间、术后12、24 h时VAS疼痛评分低于对照组,维持时间长于对照组(P<0.05)。观察组术后谵妄发生率低于对照组(P=0.007)。年龄≥80岁、观察组受伤至手术时间≥3 d、基础性疾病≥3种、手术时间≥2 h、白蛋白≤35 g·L^(-1)、术中失血量≥500 mL患者术后谵妄发生率更高(P<0.05)。logistic回归分析结果显示:年龄、受伤至手术时间、白蛋白及术中失血量是患者发生术后谵妄的影响因素(P>0.05)。结论蛛网膜下腔阻滞联合髂筋膜阻滞麻醉应用于老年髋部骨折患者的手术中效果较好,神经阻滞起效快、维持时间长,术后疼痛轻,术后谵妄发生率低。术后谵妄发生与患者年龄、受伤至手术时间、白蛋白及术中失血量有关。

Objective To explore the application effect of subarachnoid block combined with iliac fascia block in elderly patients with hip fracture surgery and the related influencing factors of postoperative delirium.Methods A total of 80 old patients who underwent surgery for hip fractures under subarachnoid block combined with iliac fascia block anesthesia in Xinyang Central Hospital from October 2021 to December 2022 were selected as the observation group,and 80 old patients who underwent surgery for hip fractures under subarachnoid block as the control group.The differences in the onset and maintenance time of motor and sensory nerves,visual analogue scale(VAS),and postoperative delirium between the two groups were observed.Results The onset time of nerve block in the observation group,as well as VAS pain scores at 12 and 24 hours after surgery were lower than those in the control group,and the maintenance time longer than that in the control group(P<0.05).The incidence of postoperative delirium in the observation group was lower than that in the control group(P=0.007).Patients aged≥80 years,observation group with injury to surgery time≥3 days,underlying diseases≥3,surgery time≥2 hours,albumin≤35 g·L^(-1),and intraoperative blood loss≥500 mL had a higher incidence of postoperative delirium(P<0.05).The logistic regression analysis results showed that age,time from injury to surgery,albumin,and intraoperative blood loss were the influencing factors for postoperative delirium in patients(P>0.05).Conclusion The application of subarachnoid block combined with iliac fascia block anesthesia in elderly patients with hip fractures has a good effect in surgery,with fast onset of nerve block,long maintenance time,mild postoperative pain,and low incidence of postoperative delirium.The occurrence of postoperative delirium is related to the patient’s age,time from injury to surgery,albumin,and intraoperative blood loss.