腰丛神经阻滞联合全麻对老年骨折手术患者麻醉药物用量的影响观察

Observation on the effect of lumbar plexus block combined with general anesthesia on the dosage of anesthetic drugs in elderly patients undergoing fracture surgery

目的探讨腰丛神经阻滞(LPB)联合全身麻醉(全麻)对老年骨折手术患者麻醉药物用量的影响。方法选择84例老年骨折手术患者,按照随机数字表法分为对照组(采用全麻方式麻醉)与观察组(采用LPB联合全麻方式进行麻醉),每组42例。比较两组手术指标、阿片类药物用量、不同时间点[插管时(T0)、手术切皮时(T1)、缝合切口时(T2)、入麻醉苏醒室0.5 h时(T3)]血流动力学指标、术后疼痛评分、不良反应发生情况。结果两组手术时间、止血带时间、输液量、手术出血量、尿量比较无明显差异(P>0.05);但观察组唤醒睁眼时间(12.46±2.36)min、拔管时间(13.84±2.47)min均短于对照组的(18.45±3.25)、(22.25±4.16)min(P<0.05)。观察组阿片类药物用量为(13.25±2.75)μg,对照组为(36.25±5.71)μg,观察组明显少于对照组(t=23.519,P=0.000<0.05)。T0时两组心率、平均动脉压比较无明显差异(P>0.05);但T1、T2、T3时观察组心率、平均动脉压均明显低于对照组(P<0.05)。观察组术后2、12、24、48 h的疼痛评分分别为(1.54±0.35)、(1.78±0.45)、(1.45±0.36)、(1.38±0.38)分,均低于对照组的(2.81±0.61)、(3.15±0.69)、(3.02±0.65)、(2.75±0.49)分(P<0.05)。观察组不良反应发生率为7.14%(3/42),对照组为26.19%(11/42),观察组低于对照组(χ^(2)=5.486,P=0.019<0.05)。结论老年骨折手术患者麻醉中采取LPB联合全麻方案,与单纯全麻方案比较,不仅可以更好地维持手术期间血流动力学稳定,而且可以减少唤醒睁眼时间、拔管时间,更好地减轻术后疼痛,还可明显减少阿片类麻醉药物用量,从而减轻药物不良反应,值得临床应用。

Objective To explore the effect of lumbar plexus block(LPB)combined with general anesthesia on the dosage of anesthetic drugs in elderly patients undergoing fracture surgery.Methods A total of 84 elderly patients with fracture surgery were selected and divided into a control group(general anesthesia)and an observation group(LPB combined with general anesthesia)according to random number table,with 42 cases in each group.Both groups were compared in terms of surgical indicators,opioid dosage,hemodynamic parameters and postoperative pain score at different time points[at the time of intubation(T0),at the time of surgical incision(T1),at the time of suturing the incision(T2),and at the time of admission to anesthesia awakening room for 0.5 h(T3)],and occurrence of adverse reactions.Results There were no significant differences in operation time,tourniquet time,infusion volume,surgical blood loss and urine volume between the two groups(P>0.05).However,the awakening time and extubation time of the observation group were(12.46±2.36)and(13.84±2.47)min,which were shorter than(18.45±3.25)and(22.25±4.16)min of the control group(P<0.05).The opioid dosage was(13.25±2.75)μg in the observation group and(36.25±5.71)μg in the control group;the observation group was significantly less than the control group(t=23.519,P=0.000<0.05).There were no significant differences in heart rate and mean arterial pressure between the two groups at T0(P>0.05).However,the heart rate and mean arterial pressure in the observation group were significantly lower than those in the control group at T1,T2 and T3(P<0.05).The pain scores of the observation group were(1.54±0.35),(1.78±0.45),(1.45±0.36)and(1.38±0.38)points at 2,12,24 and 48 h after surgery,which were lower than(2.81±0.61),(3.15±0.69),(3.02±0.65)and(2.75±0.49)points of the control group(P<0.05).The incidence of adverse reactions was 7.14%(3/42)in the observation group and 26.19%(11/42)in the control group;the observation group was lower than the control group(χ^(2)=5.486,P=0.019<0.05).Conclusion Compared with general anesthesia,LPB combined with general anesthesia can not only better maintain hemodynamic stability during surgery,but also reduce the awakening time and extubation time,better alleviate postoperative pain,and significantly reduce the dosage of opioid narcotic drugs,thus alleviating adverse drug reactions,which is worthy of clinical application.