骶前-腰大肌后间隙阻滞-选择性神经根阻滞对全麻膝下骨质疏松性骨折全身麻醉中麻醉药物用量的影响及其临床意义  

The Effect of Presacral-Retro-Psoas Space Block-Selective Nerve Root Block on the Dosage of Anesthetics in General Anesthesia for Below-Knee Osteoporotic Fractures and Its Clinical Significance

作　　者：耿玮[1] 纪玉玮 GENG Wei(The First Affiliated Hospital of Suzhou University,Jiangsu Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院,江苏苏州215000 [2]江苏省苏州市立医院,江苏苏州215008

出　　处：《河北医学》2022年第7期1172-1177,共6页Hebei Medicine

基　　金：江苏省科技项目,(编号:BK20190178)。

摘　　要：目的:探讨骶前-腰大肌后间隙阻滞-选择性神经根阻滞对膝下骨质疏松性骨折手术患者全身麻醉中麻醉药物用量影响及其临床意义。方法:选取2020年1月至2021年6月期间在本院骨外科就诊并接受手术治疗的70例膝下骨质疏松性骨折患者为对象,根据麻醉方式不同分为全麻组(n=37,实施单纯全身麻醉)和联合组(n=33,实施骶前-腰大肌后间隙阻滞-选择性神经根阻滞辅助全身麻醉)。观察联合组神经阻滞前后血流动力学指标波动情况[心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)];比较两组患者术后各时间点疼痛视觉模拟(VAS)评分、围手术期麻醉药物用量、术后恢复情况等指标的差异。结果:联合组神经阻滞后5min、10min、20min与阻滞前的HR、SBP、DBP、MAP波动情况比较无显著性差异(P>0.05)。联合组术中瑞芬太尼用量为(0.77±0.03)mg,少于全麻组(0.90±0.05)mg(P<0.05),联合组舒芬太尼补救镇痛次数为(0.84±0.14)次,均少于全麻组(1.30±0.27)次(P<0.05)。联合组术后静息状态下和运动状态下各时间点的VAS评分比较均有显著性差异(P<0.05),全麻组术后静息状态下各时间点的VAS评分比较有显著性差异(P<0.05),运动状态下各时间点的VAS评分比较无显著性差异(P>0.05),联合组术后6h、12h、24h静息状态下的VAS评分均低于全麻组(P<0.05),联合组术后12h运动状态下的VAS评分均低于全麻组(P<0.05)。6h、12h、24h静息状态下的VAS评分均低于全麻组(P<0.05),联合组术后12h运动状态下的VAS评分均低于全麻组(P<0.05)。联合组床上被动锻炼时间早于全麻组(P<0.05)。两组术后肛门排气时间比较无明显差异(P>0.05),联合组床上被动锻炼时间为(3.36±0.32)h,早于全麻组(4.02±0.33)h(P<0.05)。结论:膝下骨质疏松性骨折手术患者实施骶前-腰大肌后间隙阻滞-选择性神经根阻滞辅助全身麻醉具有稳定的血流动力学,可有效减少围手术期麻醉�Objective:To investigate the effect of presacral-retro-psoas space block-selective nerve root block on the dosage of anesthetics during general anesthesia in patients with osteoporotic fractures below the knee and its clinical significance.Methods:From January 2020 to June 2021,70 patients with osteoporotic fractures below the knee who were treated in the Department of Orthopaedic Surgery of our hospital and received surgical treatment were selected as subjects,and divided into general anesthesia group according to different anesthesia methods(n=37,Simple general anesthesia)and combined group(n=33,presacral-retro-psoas space block-selective nerve root block assisted by general anesthesia).The fluctuations of hemodynamic indexes[heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)]in the combined group before and after nerve block were observed;the pain at each time point after the operation was compared between the two groups Differences in visual analogue scale(VAS)score,perioperative anesthetic dosage,postoperative recovery and other indicators.Results:There were no significant differences in HR,SBP,DBP and MAP fluctuation at 5min,10min and 20min after nerve block in combined group compared with before the block(P>0.05).The dosage of remifentanil in the combined group was(0.77±0.03)mg,less than that in the general anesthesia group(0.90±0.05)mg(P<0.05),and the number of relief analgesia of sufentanil in the combined group was(0.84±0.14)times,less than that in the general anesthesia group(1.30±0.27)times(P<0.05).There were significant differences in VAS scores at all time points in the rest and exercise states in the combined group(P<0.05),there were significant differences in VAS scores at all time points in the rest state in the general anesthesia group(P<0.05),and there was no significant difference in VAS scores at all time points in the exercise state(P>0.05).VAS scores in the combined group at 6h,12h and 24h after surgery were lower than those in the gene

关 键 词：骶前-腰大肌后间隙阻滞 选择性神经根阻滞 全身麻醉 骨质疏松性骨折 

分 类 号：R614.2[医药卫生—麻醉学]