超声引导下股神经及坐骨神经阻滞对老年下肢骨折患者的疗效观察  

Ultrasound-guided femoral nerve and sciatic nerve block in elderly patients with lower extremity fracture

作　　者：王蒙 李前辉[1] 谢小娟[1] Wang Meng;Li Qian-hui;Xie Xiao-juan(Department of Anesthesiology,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan,China)

机构地区：[1]河南科技大学第一附属医院麻醉科,河南洛阳471000

出　　处：《四川生理科学杂志》2023年第7期1168-1170,1136,共4页Sichuan Journal of Physiological Sciences

摘　　要：目的:探讨超声引导下股神经及坐骨神经阻滞(Femoral and sciatic nerve blocks,F-SNB)对老年下肢骨折患者的麻醉效果及不良反应影响。方法:选取河南科技大学第一附属医院麻醉科2020年1月至2022年3月期间120例老年下肢骨折患者,随机分为A组和B组。A组60例给予腰硬联合麻醉(Combined spinal epidural anesthesia,CSEA),B组60例在超声引导下行F-SNB。记录两组的麻醉效果(感觉神经和运动神经阻滞的起效时间与持续时间);于术前、术后1h测定血液高凝状态凝血酶时间(Thrombin time,TT)、凝血酶原时间(Prothrombin time,PT)及活化部分凝血活酶时间(Activated partial thromboplastin time,APTT);于术前、术后24 h测定应激反应水平促肾上腺激素分泌激素(Adreno-cortico-tropic-hormone,ACTH)、皮质醇(Cortisol,COR),并统计两组患者在观察期间的不良反应发生情况。结果:两组的感觉神经和运动神经阻滞的起效时间与持续时间比较无显著差异(P>0.05)。术后1 h,B组的TT、PT及APTT较A组延长(P<0.05)。术后24 h,B组的ACTH、COR低于A组(P<0.05)。两组寒战、头痛、恶心呕吐的发生率比较无显著差异(P>0.05);B组术中的低血压、心动过缓发生率低于A组(P<0.05)。结论:超声引导下F-SNB应用于老年下肢骨折患者,与CSEA的阻滞效果相当,但其优势在于不良反应事件风险较低,安全性较好。Objective:To investigate the effects of ultrasound-guided Femoral and sciatic nerve blocks(F-SNB)on anesthesia and side effects in senile patients with lower limb fractures.Methods:A total of 120 elderly patients with lower limb fracture in the Department of Anesthesiology,The First Affiliated Hospital of Henan University of Science and Technology from January 2020 to March 2022 were selected and randomly divided into group A and Group B.Sixty patients in group A received Combined Spinal Epidural Anesthesia(CSEA),and 60 patients in group B received F-SNB under ultrasound guidance.The anesthetic effects(onset time and duration of sensory and motor tissues)were recorded in the two groups.Blood thrombin time(TT),Prothrombin time(PT)and activated partial thromboplastin time(APTT)were measured before and 1h after operation.;Stress levels adreno-cortico-tropic-hormone(ACTH)and Cortisol(COR)were measured before and 24 h after surgery,and adverse reactions of the two groups were statistically measured during the observation period.Results:There were no significant differences in the onset time and duration of sensory nerve and motor nerve block between the two groups(P>0.05).At 1h after operation,TT,PT and APTT in group B were longer than those in group A(P<0.05).24 h after operation,ACTH and COR in group B were lower than those in group A(P<0.05).There were no significant differences in the incidence of chills,headache,nausea and vomiting between the two groups(P>0.05).The incidence of hypotension and bradycardia in group B was lower than that in group A(P<0.05).Conclusions:Ultrasound-guided F-SNB has the same blocking effect as CSEA in elderly patients with lower extremity fractures,but its advantages are lower risk of adverse events and better safety.

关 键 词：老年 下肢骨折 股神经 坐骨神经 阻滞 血液高凝状态 应激反应 

分 类 号：R68[医药卫生—骨科学]