超声引导下多神经阻滞在老年踝关节骨折手术中的临床应用效果研究

Study on the clinical effect of ultrasound-guided multi-nerve block in elderly patients with ankle fractures

目的:对比超声引导下多神经阻滞和股神经-坐骨神经阻滞在老年踝关节骨折手术中的临床应用效果。方法:选取2022年1月至2024年4月期间本院收治的82例老年踝关节骨折患者作为研究对象。按照随机数字表法,将患者分为对照组和观察组,各41例。对照组采用超声引导下股神经-坐骨神经阻滞;观察组采用超声引导下多神经阻滞。分析比较两组的苏醒、拔管时间及喉罩使用率,视觉模拟评(Visual simulation score,VAS)、生命体征以及不良反应。结果:观察组的苏醒、拔管时间均显著短于对照组,且喉罩使用率明显低于对照组(P<0.05)。术后2 h、术后6 h、术后12 h、术后24 h,两组的VAS评分随术后时间增加而降低,且观察组术后2 h、6 h、12 h的VAS评分均明显低于对照组(P<0.05),但两组术后24 h的VAS评分无明显差异(P>0.05)。与T1时间点比较,对照组的T2、T3、T4时间点的平均动脉压(Mean arterial pressure,MAP)、心率(Heart rate,HR)值均明显上升(P<0.05),观察组的T2、T3、T4时间点的MAP、HR值均明显低于对照组(P<0.05)。两组的不良反应总发生率无明显差异(P>0.05)。结论:超声引导下多神经阻滞在老年踝关节骨折手术中表现出更佳的麻醉效果,具有更短的苏醒和拔管时间、更低的喉罩使用率及更优的早期镇痛效果,且能维持更稳定的生命体征。

Objective:To compare the clinical effects of multi-nerve block and femoral-sciatic nerve block guided by ultrasound in elderly patients with ankle fractures.Methods:A total of 82 elderly patients with ankle fractures admitted to our hospital from January 2022 to April 2024 were selected as the study subjects.According to the random number table method,patients were divided into a control group and an observation group,with 41 cases in each group.The control group received ultrasound-guided femoral nerve-sciatic nerve block,while the observation group underwent ultrasound-guided multi-nerve block.The awakening time,extubation time,laryngeal mask usage rate,Visual Analog Scale(VAS)score,vital signs,and adverse reactions were analyzed and compared between the two groups.Results:The recovery time and extubation time of group B were significantly shorter than that of group A,and the utilization rate of laryngeal mask was significantly lower than that of group A(P<0.05).At 2 hours,6 hours,12 hours and 24 hours after surgery,the VAS scores of the two groups showed A decreasing trend with time,and the VAS scores of the two groups at 2 hours,6 hours and 12 hours after surgery were significantly lower than those of the group A(P<0.05),but there was no significant difference in the VAS scores of the two groups at 24 hours after surgery(P>0.05).Compared with T1 time points,the MAP and HR values at T2,T3 and T4 time points in group A were significantly increased(P<0.05),and the MAP and HR values at T2,T3 and T4 time points in group B were significantly lower than those in group A(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusions:Ultrasound-guided multi-nerve block in elderly ankle fracture surgery shows better anesthetic effect,shorter recovery and extubation time,lower laryngeal mask utilization rate and better early analgesia,and can maintain more stable vital signs.