股骨粗隆间骨折患者采用B超引导闭孔神经阻滞联合髂筋膜间隙阻滞的麻醉效果研究  

Study on the anesthetic effect of obturator nerve block combined with iliac fascia space block guided by B-ultrasound in patients with intertrochanteric fracture of femur

作　　者：汪珊珊 WANG Shan-shan(Second Affiliated Hospital of Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院,116000

出　　处：《中国实用医药》2023年第10期71-74,共4页China Practical Medicine

摘　　要：目的 分析B超引导闭孔神经阻滞联合髂筋膜间隙阻滞用于股骨粗隆间骨折患者中的麻醉效果。方法 98例股骨粗隆间骨折患者,采用抽签法分为对照组及观察组,各49例。对照组予以全身麻醉,观察组在对照组基础上予以B超引导闭孔神经阻滞联合髂筋膜间隙阻滞。对比两组不同时间点[穿刺前(T0)、穿刺后10 min(T1)、手术切皮时(T2)、术后5 min(T3)]的血流动力学指标[心率(HR)、呼吸频率(RR)、平均动脉压(MAP)]水平,不同时间点[术前(t0)、进入手术室后(t1)、转侧卧位时(t2)、术后1 d(t3)]的疼痛[重症监护疼痛观察工具(CPOT)]评分、睡眠质量[匹茨堡睡眠质量指数量表(PSQI)]评分,麻醉前后的疼痛介质指标[5-羟色胺(5-HT)、前列腺素E_(2)(PGE_(2))、P物质(SP)]水平,并发症发生情况,麻醉效果。结果 两组T0时的HR、RR、MAP水平对比,差异无统计学意义(P>0.05);观察组T1、T2、T3时的HR、RR、MAP水平均高于对照组,差异具有统计学意义(P<0.05)。两组t0时的CPOT评分对比,差异无统计学意义(P>0.05);观察组t1、t2、t3时的CPOT评分均低于对照组,差异具有统计学意义(P<0.05)。观察组术后1 d的PSQI评分低于对照组,差异具有统计学意义(P<0.05)。麻醉前,两组的5-HT、PGE_(2)、SP水平对比,差异无统计学意义(P>0.05);麻醉后,观察组的5-HT、PGE_(2)、SP水平分别为(0.51±0.08)μmol/L、(26.53±2.19)ng/ml、(52.36±2.88)pg/ml,均低于对照组的(0.76±0.12)μmol/L、(50.29±3.27)ng/ml、(98.49±5.76)pg/ml,差异具有统计学意义(P<0.05)。观察组并发症发生率2.04%低于对照组的16.33%,差异具有统计学意义(P<0.05)。观察组麻醉优良率97.96%高于对照组的79.59%,差异具有统计学意义(P<0.05)。结论 B超引导闭孔神经阻滞联合髂筋膜间隙阻滞运用于股骨粗隆间骨折患者中,麻醉效果更确切,能稳定血流动力学,保障生命安全,值得推广。Objective To analyze the anesthetic effect of obturator nerve block combined with iliac fascia space block guided by B-ultrasound in patients with intertrochanteric fracture of femur.Methods A total of 98 patients with intertrochanteric fracture of femur were divided into control group and observation group by lottery method,with 49 cases in each group.The control group received general anesthesia,and the observation group received obturator nerve block combined with iliac fascia space block guided by B-ultrasound on the basis of the control group.Both groups were compared in terms of hemodynamic indexes[heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)]at different time points[before puncture(T0),10 min after puncture(T1),at skin incision(T2),and 5 min after surgery(T3)],pain[Critical-Care Pain Observation Tool(CPOT)]score and sleep quality[Pittsburgh Sleep Quality Index Scale(PSQI)]score at different time points[before surgery(t0),after entering the operating room(t1),during lateral lying position(t2),1 day after surgery(t3)],pain mediator indexes[5-hydroxytryptamine(5-HT),prostaglandin E_(2)(PGE_(2)),substance P(SP)]levels before and after anesthesia,complications,and anesthetic effect.Results At T0,there was no statistically significant difference in HR,RR and MAP between the two groups(P>0.05).The levels of HR,RR and MAP at T1,T2 and T3 in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).At T0,there was no statistically significant difference in CPOT score between the two groups(P>0.05).At t1,t2 and t3,the CPOT scores of the observation group were lower than those of the control group,and the difference was statistically significant(P<0.05).The PSQI score of the observation group 1 d after surgery was lower than that of the control group,and the difference was statistically significant(P<0.05).Before anesthesia,there were no statistically significant differences in 5-HT,PGE_(2) and SP levels between the two groups(P>0.0

关 键 词：B超引导闭孔神经阻滞 髂筋膜间隙阻滞 全身麻醉 股骨粗隆间骨折 血流动力学 疼痛介质 

分 类 号：R614[医药卫生—麻醉学]