连续股神经阻滞联合清醒镇静镇痛在老年粗隆间骨折手术中的应用  

Study on the application of continuous femoral nerve block combined with conscious sedation and analgesia in operation for elderly patients with intertrochanter fracture of femur

作　　者：李永刚[1] 赵玉彪[1] 金海松[1] 张春玉[1] 郭乃超 丁冠男[2] 

机构地区：[1]北京京煤集团总医院麻醉科,北京102300 [2]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《临床和实验医学杂志》2017年第12期1241-1243,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的评价连续股神经阻滞联合清醒镇静镇痛在老年粗隆间骨折手术中的应用效果。方法 90例老年股骨粗隆间骨折患者,随机分成连续硬膜外组(CEA组,n=30)、全凭静脉麻醉组(TIVA组,n=30)和连续股神经阻滞组(CFNB组,n=30),分别在连续硬膜外麻醉、全凭静脉麻醉和连续股神经阻滞联合清醒镇静镇痛下完成手术。观察三组患者的麻醉准备时间、血流动力学稳定性、镇痛效果评分、麻醉满意度评分以及不良反应。结果 CFNB组麻醉准备时间明显短于CEA组(P<0.05),而与TIVA组无显著差异(P>0.05)。CFNB组术中血流动力学稳定性明显优于CEA组和TIVA组(P<0.05)。CFNB组镇痛效果评分明显高于TIVA组(P<0.05),而与CEA组无显著差异(P>0.05)。三组患者的麻醉满意度评分无显著性差异(P>0.05)。CFNB组恶心呕吐的发生率明显低于TIVA组和CEA组(P<0.05)。CFNB组尿潴留的发生率明显低于CEA组(P<0.05)。三组间术后谵妄的发生率无显著性差异(P>0.05)。结论连续股神经阻滞联合清醒镇静镇痛是一种适合于老年患者股骨粗隆间骨折手术的麻醉方法。Objective To evaluate the application of continuous femoral nerve block( CFNB) combined with conscious sedation and analgesia( CSA) in operation for elderly patients with intertrochanter fracture of femur( IFF). Methods Ninety patients with IFF undergoing the operation were randomly allocated in three groups. Patients in CEA group( n = 30) received continuous epidural anesthesia,patients in TIVA group( n = 30) received total intravenous anesthesia,and patients in CFNB group( n = 30) received CFNB combined with CSA. Items including preparation time for anesthesia( PTA),stability of homodynamics( SH),analgesia scale( AS),scale of satisfaction for anesthesia( SSA),and side effects were observed. Results PTA in patients of CFNB group was significantly shorter than that of patients in CEA group( P < 0. 05). The stability of hemodynamics( SH) in patients of CFNB group was significantly higher than that of patients in CEA and TIVA groups( P < 0. 05). Analgesia scale in patients of CFNB group was significantly higher than that of patients in TIVA group( P < 0. 05). There was no significant difference in scale of satisfaction for anesthesia( SSA) among these groups( P > 0. 05). Nausea and vomiting in patients of CFNB group were significantly lower than those of patients in CEA and TIVA groups( P < 0. 05). Urinary retention in patients of CFNB group was significantly lower than that of patients in CEA group( P < 0. 05). There was no significant difference in postoperative delirium among groups( P > 0. 05). Conclusion CFNB combined with CSA is a suitable method for anesthesia applied in the operation for elderly patients with IFF.

关 键 词：老年人 股骨粗隆间骨折 连续股神经阻滞 清醒镇静镇痛 

分 类 号：R614[医药卫生—麻醉学]