不同穿刺间隙蛛网膜下腔阻滞在高龄患者股骨粗隆骨折手术中的应用比较  

Comparison of different puncture spaces spinal anesthesia in elderly patients with intertrochanteric fracture surgery

作　　者：张宝 靳涛 崔静静 刘文平 ZHANG Bao;JIN Tao;CUI Jing-jing;LIU Wen-ping(Department of Anesthesiology,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061001,China)

机构地区：[1]沧州中西医结合医院麻醉科,河北沧州061001

出　　处：《武警后勤学院学报（医学版）》2021年第9期44-46,共3页Journal of Logistics University of PAP（Medical Sciences）

基　　金：2020年度河北省医学科学研究课题计划(No.20200619)。

摘　　要：【目的】比较L2-L3与L3-L4穿刺间隙蛛网膜下腔阻滞在高龄患者股骨粗隆骨折手术中的应用效果。【方法】选取2020年9月至2021年5月在本院拟行股骨粗隆骨折内固定术的高龄患者40例,采用随机数字表法分为两组,各20例。两组术中均行蛛网膜下腔阻滞麻醉,其中L2-L3组以L2-L3为穿刺点,L3-L4组以L3-L4为穿刺点,麻醉药液均为盐酸罗哌卡因(3 ml:7.5 mg),比较两组麻醉效果、血流动力学、改良Bromage评分及不良反应情况。【结果】L2-L3组感觉阻滞起效时间、感觉阻滞持续时间与L3-L4组相比无显著差异(P>0.05),最高阻滞平面高于L3-L4组(P<0.05)。术毕,L2-L3组改良Bromage评分为(2.27±0.50)分,显著高于L3-L4组的(1.85±0.43)分(P<0.05)。两组各时间点心率、平均动脉压及不良反应发生率比较无差异(P>0.05)。【结论】高龄患者股骨粗隆骨折术中,在L2-L3、L3-L4中的任一间隙注药行蛛网膜下腔阻滞,均安全可靠。【Objective】To compare the application effect of spinal anesthesia with L2-L3 and L3-L4 puncture space in the operation of elderly patients with intertrochanteric fracture surgery.【Methods】A total of 40 elderly patients scheduled for internal fixation of femoral intertrochanteric fractures in our hospital from September 2020 to May 2021 were selected and randomly divided into two groups,with 20 cases in each group.Spinal anesthesia was performed in both groups.L2-L3 was used as puncture point in L2-L3 group,L3-L4 was used as puncture point in L3-L4 group,and ropivacaine hydrochloride(3 ml:7.5 mg)was used as anesthetic solution.The anesthetic effect,hemodynamics,modified Bromage score and adverse reactions were compared between the two groups.【Results】There was no significant difference in the onset time of sensory block between the L2-L3 group and the L3-L4 group(P>0.05).The duration of sensory block in the L2-L3 group was shorter than that in the L3-L4 group(P<0.05).The maximum block plane and the proportion of epidural addition were higher than those in the L3-L4 group(P<0.05).After operation,the modified Bromage score of L2-L3 group was(2.27±0.50)points,which was significantly higher than that of L3-L4 group[(1.85±0.43)points](P<0.05).There was no significant difference in heart rate(HR),mean arterial pressure(MAP)and incidence of adverse reactions between the two groups at each time point(P>0.05).【Conclusion】In the operation of femoral intertrochanteric fractures in elderly patients,it is safe and reliable to inject drugs into any space of L2-L3 and L3-L4 for subarachnoid block.

关 键 词：蛛网膜下腔阻滞 股骨粗隆骨折 阻滞平面 血流动力学 穿刺部位 

分 类 号：R614[医药卫生—麻醉学]