超声引导下肢神经阻滞复合右美托咪定在老年股骨颈骨折术中的应用  

Application of Ultrasound-Guided Lower Extremity Nerve Block Combined with Dexmedetomidine in Older Patients Undergoing Surgery for Femoral Neck Fracture

作　　者：李秋军[1] 郑少强[1] 杨小宇[1] 张文超[1] 王庚[1] Li Qiujun;Zheng Shaoqiang;Yang Xiaoyu;Zhang Wenchao;Wang Geng(Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing 100035)

机构地区：[1]北京积水潭医院麻醉科,北京100035

出　　处：《国际老年医学杂志》2023年第2期187-190,共4页International Journal of Geriatrics

基　　金：北京积水潭医院高层次人才“学科骨干”培养计划(XKGG202116)。

摘　　要：目的分析超声引导下肢神经阻滞复合右美托咪定(DEX)在老年股骨颈骨折术中的应用价值。方法选取2020年7月~2022年7月北京积水潭医院住院的123例老年股骨颈骨折手术患者进行回顾性分析,根据麻醉方法的不同分组,接受全身麻醉复合DEX的61例为全麻组,接受超声引导下肢神经阻滞复合DEX的62例为超声组,比较两组入室时(T_(0))、神经阻滞操作前(T_(1))、手术切皮即刻(T_(2))、手术开始15 min(T_(3))、手术开始30 min(T_(4))、手术结束(T_(5))各时间点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SaO_(2)),比较两组术后2 h、4 h、8 h的视觉模拟自评量表(VAS)评分、Ramsay镇静评分,DEX用量、按压镇痛泵次数及不良反应发生情况。结果超声组T_(2)、T_(3)、T_(4)时的HR、MAP均低于全麻组、T_(1)、T_(5)时的HR、MAP均高于全麻组(P<0.05),两组T_(1)~T_(5)各时间点的SaO_(2)比较,差异均无统计学意义(P>0.05)。超声组术后2 h、4 h、8 h的VAS评分均低于全麻组、Ramsay镇静评分均高于全麻组(P<0.05)。超声组DEX用量、按压镇痛泵次数均低于全麻组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论老年股骨颈骨折手术中通过超声引导下肢神经阻滞复合DEX麻醉效果好,安全性较高。Objective To evaluate the value of ultrasound-guided lower extremity nerve block combined with dexmedetomidine(DEX)in older people undergoing surgery for femoral neck fracture.Methods A retrospective analysis was conducted on 123 older patients undergoing surgery for femoral neck fracture from July 2020 to July 2022.According to the anesthesia methods,the patients were divided into two groups.Sixty-one cases receiving general anesthesia and DEX were assigned to the general anesthesia group,and 62 cases receiving ultrasound-guided lower extremity nerve block and DEX were assigned to the ultrasound group.Heart rate(HR),mean arterial pressure(MAP)and blood oxygen saturation(SaO_(2))were compared between the two groups at the time of entering operating room(T0),before nerve block(T1),immediately after skin resection(T2),15 min after operation(T3),30 min after operation(T4),and at the end of operation(T5).The visual analogue scale(VAS)score,Ramsay sedation score,DEX dosage,frequency of pressing analgesic pump,and incidence of adverse reactions were compared between the two groups at 2,4,and 8 hours after operation.Results HR and MAP at T2,T3 and T4 in the ultrasound group were lower than those in the general anesthesia group,HR and MAP at T1 and T5 were higher than those in the general anesthesia group(P<0.05).There was no significant difference in SaO_(2)at T1 to T5 between the two groups(P>0.05).The VAS score at 2,4 and 8 hours after operation in the ultrasound group was lower than that in the general anesthesia group,and Ramsay sedation score was higher than that in the general anesthesia group(P<0.05).The dosage of DEX and the frequency of pressing analgesia pump in the ultrasound group were lower than those in the general anesthesia group(P<0.05).There was no significant difference in the overall incidence of adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided lower extremity nerve block combined with DEX,has good effect with few adverse reactions and high safety in older adults undergoi

关 键 词：超声引导 下肢神经阻滞 右美托咪定 股骨颈骨折 

分 类 号：R614[医药卫生—麻醉学]