摘要
目的评价超声引导下“沙漏征”髂筋膜-骶丛神经阻滞联合臀上皮神经阻滞应用于老年粗隆间骨折股骨近端髓内钉(proximal femoral intramedullary nail,PFN)内固定术的效果。方法选取2018年6月至2020年1月保定市第一中心医院拟择期行单侧股骨粗隆间骨折PFN内固定术患者80例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ~Ⅲ级,年龄65~85岁,按照随机数字表法分为研究组(GS组)和对照组(EA组),每组40例。GS组在超声引导下行“沙漏征”髂筋膜-骶丛神经阻滞联合臀上皮神经阻滞;EA组采用腰硬联合麻醉。记录两组麻醉实施完成率及麻醉总有效率;记录两组麻醉方法的操作时间,感觉神经阻滞、运动神经阻滞的完善时间,以及麻醉镇痛持续时间;监测两组血流动力学情况,比较术后1 h(T_(1))、3 h(T_(2))、6 h(T_(3))、12 h(T_(4))、24 h(T_(5))、48 h(T_(6))时点的视觉模拟评分(visual analogue score,VAS);记录并发症与不良反应的发生率。结果GS组的麻醉实施完成率高于EA组,麻醉镇痛持续时间明显长于EA组,T_(3)、T_(4)、T_(5)、T_(6)时点VAS明显低于EA组,差异均有统计学意义(P<0.05);GS组MAP不同时点变化约为基线值的5%,心率约为7%,与EA组相比波动不大,保持相对稳定;两组均未有局部麻醉药中毒反应发生,GS组不良反应发生率以及并发症发生率低于EA组,差异有统计学意义(P<0.05)。结论超声引导下“沙漏征”髂筋膜-骶丛阻滞联合臀上皮神经阻滞,可减轻摆放体位引起的疼痛,麻醉实施完成率较高,能有效应用于老年PFN内固定术,术中血流动力学较稳定,术后镇痛效果好且维持时间久,不良反应少,实践了加速术后康复理念。
Objective To evaluate the effect of ultrasound-guided"hourglass-pattern"iliac fascia-sacral plexus block combined with gluteal epithelial nerve block in the treatment of proximal femoral intramedullary nail(PFN)internal fixation of intertrochanteric fracture in the elderly patients.Methods Eighty patients were scheduled for PFN internal fixation of intertrochanteric fracture.They were divided into group GS and group EA according to the random number table.Under the guidance of ultrasound,the"hourglass-pattern"iliac fascia block combined with sacral plexus and gluteal epithelial nerve block were performed in group GS.Combined spinal-epidural anesthesia was performed in group EA.The completion rate and effective rate of anesthesia of the two groups were recorded;the operation time,the perfect time of sensory nerve block and motor nerve block,and the duration of anesthesia and analgesia in the two groups were recorded.The hemodynamics of the two groups were monitored.The incidence of complications during anesthesia were recorded.Results The anesthesia completion rate of group GS was higher than that of group EA(P<0.01).The duration of anesthesia and analgesia in group GS was significantly longer than that in group EA(P<0.01).MAP changes at different time points in group GS were remained relatively stable.The adverse reactions and complications of group GS were lower than those of group EA(P<0.05).Conclusions Ultrasound-guided"hourglass-pattern"iliac fascia-sacral plexus block combined with gluteal epithelial nerve block can provide effective perioperative anesthesia and analgesia for the elderly patients with hip fracture,has fewer adverse reactions.
作者
王会月
王春光
刘嘉运
吴安石
Wang Huiyue;Wang Chunguang;Liu Jiayun;Wu Anshi(Department of Anesthesia,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《北京医学》
CAS
2021年第3期224-227,231,共5页
Beijing Medical Journal
基金
保定市科技计划自筹经费项目(1951ZF066)。
关键词
“沙漏征”髂筋膜阻滞
骶丛阻滞
臀上皮神经阻滞
粗隆间骨折股骨近端髓内钉内固定术
镇痛
"hourglass-pattern"iliac fascia block
sacral plexus block
gluteal epithelial nerve block
proximal femoral intramedullary nail internal fixation for intertrochanteric fracture
analgesia
