摘要
目的探讨静脉麻醉复合外周神经阻滞在老年股骨近端骨折手术中的应用效果。方法回顾性纳入2012年1月至2020年12月于焦作煤业(集团)有限责任公司中央医院行股骨近端骨折手术的老年患者812例,年龄66~79岁,根据麻醉方案分为两组。静脉麻醉组398例行单纯静脉麻醉,复合麻醉组414例行静脉麻醉复合右美托咪定、罗哌卡因外周神经阻滞麻醉。比较两组患者的阻滞起效时间及阻滞维持时间、术后镇静程度及手术区域疼痛程度、术后血清相关炎症因子水平及不良反应。结果静脉麻醉组感觉神经和运动神经阻滞起效时间均长于复合麻醉组(P均<0.05),而感觉神经和运动神经阻滞维持时间均少于复合麻醉组(P均<0.05)。术后6、12、24 h,两组患者镇静程度比较,均无统计学差异(P均>0.05)。术后6、12、24 h,复合麻醉组手术区域疼痛程度低于静脉麻醉组(t=6.066、6.835、5.139,P均<0.05)。术后6、24 h,两组血清皮质醇、白细胞介素-6水平均高于术前(P均<0.05),且复合麻醉组患者血清皮质醇、白细胞介素-6水平均低于静脉麻醉组(P均<0.05)。两组不良反应发生率比较,无统计学差异(χ^(2)=0.001,P=0.970)。结论静脉麻醉复合右美托咪定、罗哌卡因外周神经阻滞麻醉用于老年股骨近端骨折手术的阻滞效果好,镇痛和镇静效果好,对机体影响小,安全性较高。
Objective To investigate the effect of intravenous anesthesia combined with peripheral nerve block anesthesia in elderly patients undergoing surgery of proximal femoral fracture.Methods A total of 812 elderly patients undergoing proximal femoral fracture surgery admitted to Jiaozuo Coal Industry Group Central Hospital from January 2012 to December 2020 were retrospectively collected,aged 66 to 79 years,and divided into two groups according to the anesthesia plan,398 patients in the intravenous anesthesia group received simple intravenous anesthesia,and 414 patients in the combined anesthesia group received intravenous anesthesia combined with dexmedetomidine and ropivacaine peripheral nerve block anesthesia.The onset and maintenance time of the block,the degree of postoperative pain in the operation area,the level of related inflammatory factors,and the adverse reactions were compared between the two groups.Results The onset time of nerve block in the intravenous anesthesia group was longer than that in the combined anesthesia group(P<0.05),while the maintenance time of nerve block was shorter than that in the combined anesthesia group(P<0.05).At 6,12,and 24 h after surgery,the pain degree of the operation area in the combined anesthesia group was lower than that in the intravenous anesthesia group(t=6.066,6.835,5.139,P<0.05).At 6 and 24 h after operation,the levels of serum cortisol and interleukin-6 in the two groups were higher than those before operation(P<0.05),but which in the combined anesthesia group was lower than those in the intravenous anesthesia group(P<0.05).The incidence of adverse reactions was compared between the two groups,χ^(2)=0.001,P=0.970.Conclusions Intravenous anesthesia combined with dexmedetomidine and ropivacaine peripheral nerve block anesthesia for elderly proximal femoral fractures has good anti-inflammatory,analgesic and sedative effects and high safety.
作者
王静
Wang Jing(Department of Anesthesiology,Jiaozuo Coal Industry Group Central Hospital,Jiaozuo 454000,China)
出处
《中国实用医刊》
2021年第22期43-46,共4页
Chinese Journal of Practical Medicine
关键词
麻醉
外周神经阻滞
老年
股骨近端骨折
Anesthesia
Peripheral nerve block
Elderly
Proximal femoral fracture
