超声引导神经阻滞复合全身麻醉对创伤性胫腓骨骨折患者的应用研究

Ultrasound-guided Nerve Block Combined with General Anesthesia in Patients with Traumatic Tibiofibular Fractures

目的:分析超声引导下腘窝处坐骨神经-股神经阻滞复合全身麻醉对创伤性胫腓骨骨折患者血流动力学及术后谵妄的影响,以探讨其应用效果。方法:回顾性纳入2022年1月—2023年11月乐平市中医医院收治的110例创伤性胫腓骨骨折患者的临床资料,根据术中采用的麻醉方法分为对照组(45例)和观察组(65例)。对照组采取全身麻醉诱导手术,观察组采用超声引导的神经阻滞复合全身麻醉。观察患者血流动力学及术后谵妄情况。结果:观察组气管拔管和苏醒时间均早于对照组,丙泊酚用量明显少于对照组(P<0.05)。麻醉前,两组收缩压及心率比较,差异均无统计学意义(P>0.05);麻醉结束时,观察组收缩压及心率均明显高于对照组(P<0.05)。术后1、2、3 d,观察组术后谵妄[简易智能精神状态检查量表(MMSE)]评分高于对照组,静息状态下疼痛视觉模拟评分法(VAS)评分明显低于对照组(P<0.05)。结论:超声引导神经阻滞复合全身麻醉治疗创伤性胫腓骨骨折患者,有利于手术中血流动力学管理,减少阿片类镇痛药物的使用,减少患者术后谵妄发生率,安全性良好。

Objective:To analyze the effects of ultrasound-guided sciatic-femoral nerve block at the popliteal fossa combined with general anesthesia on hemodynamics and postoperative delirium in patients with traumatic tibiofibular fracture,to explore the effects of its application.Method:The clinical date of 110 patients with traumatic tibiofibular fracture admitted to Leping Hospital of Traditional Chinese Medicine from January 2022 to November 2023 were retrospectively included and divided into control group(45 cases)and observation group(65 cases)according to the anesthesia method adopted during the operation.The control group received general anesthesia induction operation,and the observation group was given ultrasound-guided nerve block combined with general anesthesia.The hemodynamics and postoperative delirium were observed.Result:The time of tracheal extubation and recovery in the observation group were earlier than those in the control group,the dosage of Propofol was significantly lower than that in the control group(P<0.05).Before anesthesia,there were no statistically significant differences in the systolic blood pressure and heart rate of two groups(P>0.05);at the end of anesthesia,the systolic blood pressure and heart rate of the observation group were significantly higher than those of the control group(P<0.05).At 1,2 and 3 days after operation,the postoperative delirium[mini-mental state examination(MMSE)]scores in the obsevation group were higher than those in the control group,and the scores of visual analogue scale(VAS)at rest in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:Ultrasound-guided nerve block combined with general anesthesia can maintain hemodynamic stability in patients with traumatic tibiofibular fracture,reduce the use of opioid analgesics,and reduce the incidence of postoperative delirium in patients with traumatic tibia and fibula fractures.