摘要
探讨在下肢骨折手术老年患者中实施超声引导下股神经及坐骨神经阻滞麻醉的效果。方法:将本院2019年12月-2020年12月收治的62例下肢骨折手术老年患者随机分为对照组(n=31)和观察组(n=31),对照组单纯予以全身麻醉,观察组应用全麻复合股神经及坐骨神经阻滞,比较2组生命体征变化、麻醉效果、凝血功能指标、不良反应情况。结果:2组麻醉诱导前(T1)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))水平比较差异无统计学意义(P>0.05);观察组切片时(T2)、术中1小时(T3)、拔除喉罩(T4)等各时间段的MAP、HR、SpO_(2)水平波动小于对照组,差异均有统计学意义(P<0.05);2组T2、T3、T4等各时间段的SpO_(2)水平比较差异无统计学意义(P>0.05);观察组瑞芬太尼为(0.23±0.06)mg、丙泊酚为(374.38±49.72)mg等麻醉药用量少于对照组的(0.44±0.07)mg、(662.47±51.26)mg,且术后疼痛评分为(3.05±0.36)分,低于对照组的(6.31±1.27)分,差异均有统计学意义(P<0.05);观察组喉罩拔出时的凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)均较对照组明显延长,且术中60分钟时的PT较对照组明显延长,差异均有统计学意义(P<0.05);观察组术后不良反应发生率为9.68%,较对照组的35.48%更低(P<0.05)。结论:在老年下肢骨折手术患者麻醉中应用超声引导下全麻复合股神经及坐骨神经阻滞,可保证患者围术期血流动力学更加平稳,进一步优化麻醉效果,减少麻醉药物用量,血液高凝状态也有所改善,且术后不良反应少。
To investigate the effect of ultrasound-guided femoral nerve and sciatic nerve block anes-thesia in elderly patients with lower limb fracture surgery.Methods:62 cases of elderly patients with lower limb frac-ture surgery in our hospital from December 2019 to December 2020 were randomly divided into control group(n=31)and observation group(n=31).The control group was only given general anesthesia,and the observation group was given general anesthesia combined with femoral nerve and sciatic nerve block.The changes of vital signs,anesthetic effect,indicators of coagulation function and adverse reactions of the two groups were compared.Results:There was no significant difference between the two groups in the levels of mean arterial pressure(map),heart rate(HR)and blood oxygen saturation(SpO_(2))before anesthesia induction(T1)(P>0.05).The fluctuations of map,HR and SpO_(2) levels in the observation group at the time of sectioning(T2),1H during operation(T3),and removal of laryngeal mask(T4)were less than those in the control group(P<0.05).There was no significant difference in SpO_(2) levels between the two groups at the time of T2,T3,T4(P>0.05);The dosage of remifentanil(0.23±0.06 mg),propofol(374.38±49.72 mg)and other anesthetics in the observation group was less than that in the control group(0.44±0.07 mg,662.47±51.26 mg),and the postoperative pain score(3.05±0.36 points)was lower than that in the control group(6.31±1.27 points),the difference was statistically significant(P<0.05);The thrombin time(TT),activated partial thromboplastin time(APTT)and prothrombin time(PT)in the ob-servation group were significantly longer than those in the control group when the laryngeal mask was pulled out,and the Pt at 60min during the operation was significantly longer than that in the control group,the difference was statisti-cally significant(P<0.05);The incidence of postoperative adverse reactions in the observation group(9.68%)was lower than that in the control group(35.48%)(P<0.05).Conclusion:The application of ultrasound-guided general anesthesia combined with femoral nerve and sciatic nerve block in the anesthesia of elderly patients with lower limb fracture surgery can ensure that the hemodynamics of patients during the perioperative period is more stable,further optimize the anesthesia effect,reduce the dosage of anesthetic drugs,improve the blood hypercoagula-bility,and have less postoperative adverse reactions.
作者
刘永峰
王英
LIU Yong-feng;WANG Ying(Department of anaesthesia,Dongda hospital of Shanxian,Shanxian,Shandong 274300)
出处
《中国伤残医学》
2022年第22期18-21,共4页
Chinese Journal of Trauma and Disability Medicine
关键词
超声引导
下肢骨折手术
股神经
坐骨神经阻滞
老年患者
Ultrasound guidance
Lower limb fracture surgery
Femoral nerve
Sciatic nerve block
Elderly patients
