超声引导坐骨神经联合股神经阻滞在老年患者下肢骨折手术中的麻醉效果分析  

Analysis of anesthesia effect of ultrasound-guided sciatic nerve combined with femoral nerve block in elderly patients with lower extremity fracture surgery

作　　者：韩劲松[1] 苏孟勤 HAN Jin-song;SU Meng-qin(Zhoukou Central HOSPITAL,Zhoukou Henan 466000,China;Henan Provincial Hospital,Zhengzhou 450000,China)

机构地区：[1]周口市中心医院麻醉科,河南周口466000 [2]河南省省立医院手术麻醉部,郑州450000

出　　处：《医药论坛杂志》2023年第5期41-44,49,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划(联合共建)(LHGJ20190840)。

摘　　要：目的探讨超声引导坐骨神经联合股神经阻滞在老年患者下肢骨折手术中的麻醉效果,为临床优化麻醉方案提供佐证依据。方法选取我院2020年9月—2022年9月骨科收治的200例老年下肢骨折患者纳入本次研究,患者入院时,以随机数字表分为观察组、对照组,每组100例,对照组采用全身麻醉方案,观察组选择在对照组麻醉基础上,增加超声引导下坐骨神经联合股神经阻滞的麻醉术式,对比两组患者血流动力学表现、术中不良反应、麻醉效果、麻醉术后恢复时间及术后凝血功能。结果两组患者在性别、年龄、ASA分级、手术类型及所合并慢性疾病种类等一般资料方面差异不显著(P>0.05);两组患者麻醉前后HR、MAP水平差异不显著(P>0.05);两组患者苏醒时间、拔除喉罩时间、阻滞起效时间及阻滞持续时间差异不显著(P>0.05);观察组总不良反应发生率显著低于对照组(P<0.05);观察组麻醉术后恢复时间(术后排尿恢复时间、下肢运动恢复时间)显著低于对照组(P<0.05);两组患者术后1 h凝血功能(TT、PT)较之术前均增加,且观察组显著高于对照组(P<0.05)。结论超声引导坐骨神经联合股神经阻滞应用于老年患者下肢骨折,在满足麻醉效果的前提下,能够有效降低术后麻醉不良反应出现,减轻患者术后血液高凝状态,有效缩短患者术后恢复时间,可作为临床优化麻醉方案的可行性选择。Objective To investigate the anesthetic effect of ultrasound-guided sciatic nerve combined with femoral nerve block in elderly patients with lower extremity fracture surgery,so as to provide evidence for clinical optimization of anesthesia plan.Methods A total of 200 elderly patients with lower limb fractures admitted to the Department of Orthopedics in our hospital from September 2020 to September 2022 were selected and included in this study.When the patients were admitted,they were divided into observation group and control group by random number table,with 100 patients in the two groups respectively.The anesthesia method of sciatic nerve combined with femoral nerve block under ultrasound guidance was added.The hemodynamic performance,anesthetic effect,intraoperative adverse reactions,recovery time after anesthesia and postoperative coagulation function were observed and compared between the two groups.Results There were no significant differences in gender,age,ASA classification,type of surgery and types of chronic diseases between the two groups(P>0.05).There were no significant differences in HR and MAP levels between the two groups before and after anesthesia(P>0.05).There were no significant differences in recovery time,removal time of laryngeal mask,onset time of block and duration of block between the two groups(P>0.05).The incidence of total adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).The recovery time(postoperative urination recovery time and lower limb movement recovery time)of the observation group was significantly lower than that of the control group(P<0.05).The coagulation function(TT and PT)of the two groups at 1h after operation were prolonged compared with those before operation,and the above indexes of the observation group were significantly higher than those of the control group(P<0.05).Conclusion Ultrasond-guided sciatic nerve combined with femoral nerve block in elderly patients with lower limb fractures can effectively reduce

关 键 词：超声引导 坐骨神经 神经阻滞 全身麻醉 老年患者 下肢骨折 

分 类 号：R614[医药卫生—麻醉学]