超声引导下髂筋膜阻滞联合腰麻在老年股骨转子间骨折闭合复位内固定术中的应用  

Application of ultrasound-guided fascia iliaca block combined with lumbar anesthesia in closed reduction and internal fixation for intertrochanteric fractures in elderly patients

作　　者：朱娟[1] 马鹏 蒋鹏[1] ZHU Juan;MA Peng;JIANG Peng(Department of Anesthesiology, the Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu 212001, China)

机构地区：[1]江苏大学附属医院麻醉科,江苏镇江212001

出　　处：《江苏大学学报（医学版）》2022年第4期345-349,共5页Journal of Jiangsu University：Medicine Edition

基　　金：镇江市社会发展指导性科技计划项目(FZ2020032)。

摘　　要：目的:探讨超声引导下腹股沟韧带上髂筋膜阻滞联合腰麻对老年股骨转子间骨折闭合复位内固定术的影响。方法:选择2019年9月至2021年9月在我院行闭合复位股骨近端防旋髓内钉固定的老年转子间骨折患者60例,随机分为观察组30例(超声引导下髂筋膜阻滞联合腰麻),对照组30例(单纯腰麻),记录两组患者一般情况、不同时间点血流动力学指标(平均动脉压、心率)、炎性指标(C反应蛋白、IL-6)、视觉模拟评分(VAS)、术后加强镇痛用药情况及麻醉相关并发症发生率。结果:腰麻摆体位时观察组平均动脉压、心率均低于对照组(P均<0.05);两组术后1 d血清C反应蛋白、IL-6水平均明显高于术前(P均<0.05),而观察组术后1 d血清C反应蛋白、IL-6水平均低于对照组(P<0.05)。观察组腰麻摆体位时及术后12 h、24 h、48 h VAS评分均低于对照组(P均<0.05);观察组术后首次加强镇痛用药时间明显长于对照组(P<0.05),术后加强镇痛用药使用率均低于对照组(P<0.05);两组麻醉相关并发症发生率比较无差异(P>0.05)。结论:超声引导下腹股沟韧带上髂筋膜阻滞联合腰麻应用于老年股骨转子间骨折患者行闭合复位内固定术可以减少腰麻摆体位时疼痛,稳定围手术期生命体征,减轻炎性反应,提供有效的术后镇痛,并不增加麻醉相关不良反应。Objective:To investigate the effect of ultrasound-guided supra-inguinal fascia iliaca block combined with lumbar anesthesia on closed reduction and internal fixation for intertrochanteric fractures in elderly patients.Methods:From September 2019 to September 2021,60 elderly patients with intertrochanteric fracture who received closed reduction of proximal femoral anti-rotation intramedullary nail fixation in our hospital were enrolled and randomly divided into observation group(ultrasound-guided fascia iliaca block combined with lumbar anesthesia,30 cases)and control group(lumbar anesthesia alone,30 cases).General conditions,hemodynamic indexes(mean arterial pressure and heart rate),inflammatory cytokine(CRP and IL-6),visual analogue scale(VAS),postoperative intensification of analgesia and incidence of anesthesia related complications in 2 groups were recorded.Results:The average arterial pressure and heart rate of the observation group were lower than those of the control group in the position of lumbar anesthesia(both P<0.05).The levels of CRP and IL-6 of 1d after operation in both groups were higher than that before operation(P<0.05),while the levels of CRP and IL-6 of 1d after operation in the observation group was lower than those in the control group(both P<0.05).VAS of the observation group at lumbar anesthesia position,12 h,24 h and 48 h postoperation were significantly lower than those of the control group(both P<0.05).The time of the first postoperative intensive analgesia in the observation group was significantly longer than that in the control group(P<0.05),and the utilization rate of postoperative intensive analgesic drugs in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in the incidence of anesthesia related complications between the two groups(P>0.05).Conclusion:Ultrasound-guided suprainguinal fascia iliaca block combined with lumbar anesthesia for closed reduction and internal fixation in elderly patients with intertrocha

关 键 词：超声 髂筋膜阻滞 股骨转子间骨折 腰麻 内固定 血流动力学 老年患者 

分 类 号：R614[医药卫生—麻醉学]