超声引导下腰骶丛神经阻滞在老年股骨骨折患者股骨近端防旋型髓内钉手术中的应用  

Application of Ultrasound-Guided Lumbarsacral Plexus Block in Proximal Femoral Anti Rotation Intramedullary Nail Surgery in Elderly Patients with Femoral Fractures

作　　者：张瑞权 梁超 赵闯 李志刚 ZHANG Ruiquan;LIANG Chao;ZHAO Chuang;LI Zhigang(Department of Anesthesia and Perioperative Medicine,General Hospital of Pingmei Shenma Group,Pingdingshan 467000,China)

机构地区：[1]平煤神马集团总医院麻醉与围术期医学科,河南平顶山467000

出　　处：《河南医学研究》2024年第7期1273-1277,共5页Henan Medical Research

摘　　要：目的探讨超声引导下腰骶丛神经阻滞在老年股骨骨折患者股骨近端防旋型髓内钉(PFNA)手术中的应用效果。方法选取2020年1月至2022年12月在平煤神马集团总医院诊治的90例老年股骨骨折患者,均接受PFNA手术,随机分为对照组和研究组,各45例。对照组接受传统神经刺激仪引导下后路腰丛联合坐骨神经阻滞麻醉,研究组接受超声引导下腰骶丛神经阻滞麻醉。比较两组视觉模拟评分法(VAS)评分、谵妄评定方法中文修订版(CAM-CR)评分、不良反应发生情况和术后康复相关指标。结果术后2、6、12、24、48 h研究组VAS评分低于对照组(P<0.05)。术后2、3 d研究组CAM-CR评分降低(P<0.05),术后1、2、3 d对照组CAM-CR评分升高(P<0.05),术后1、2、3 d研究组CAM-CR评分低于对照组(P<0.05)。研究组不良反应发生率低于对照组(P<0.05)。研究组呼之眨眼时间、呼之握拳时间、苏醒时间、拔管时间、首次下床活动时间、住院时间短于照组(P<0.05),住院费用少于对照组(P<0.05)。结论超声引导下腰骶丛神经阻滞应用于老年股骨骨折患者股骨PFNA手术可有效减轻术后疼痛,降低术后谵妄和不良反应,促进患者恢复,减少住院费用。Objective To explore the anesthesia effect of ultrasound-guided lumbosacral plexus block on proximal femoral anti rotation intramedullary nail(PFNA)surgery in elderly patients with femoral fractures.Methods A total of 90 elderly patients with femoral fractures who were diagnosed and treated in General Hospital of Pingmei Shenma Group from January 2020 to December 2022 were randomly divided into control group and study group,with 45 cases in each group.The control group received traditional nerve stimulator guided posterior lumbar plexus combined with sciatic nerve block anesthesia,while the study group received ultrasound-guided lumbar sacral plexus block anesthesia.The visual analogue scale(VAS)scores,Chinese revised version of the delirium assessment method(CAM-CR)scores,the occurrence of adverse reactions and postoperative rehabilitation related indicators were compared between the two groups.Results The VAS scores of the study group were lower than those of the control group at 2,6,12,24,and 48 hours after surgery(P<0.05).The CAM-CR scores in the study group were lower than before surgery on the 2nd and 3rd postoperative days(P<0.05),while the CAM-CR scores in the control group were higher than before surgery on the 1,2,and 3 days after surgery(P<0.05).The CAM-CR scores in the study group were lower than those in the control group on the 1,2,and 3 days after surgery(P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group(P<0.05).The blink time,fist clenching time,awakening time,extubation time,first time out of bed activity time,and hospitalization time of the study group were significantly shorter than those of the control group(P<0.05).The hospitalization expenses of the study group were lower than those of the control group(P<0.05).Conclusion Ultrasound guided lumbosacral plexus block applied in elderly patients with femoral fractures undergoing femoral PFNA surgery can effectively alleviate postoperative pain,reduce postoperative delirium and adverse reaction

关 键 词：股骨骨折 超声 腰骶丛神经阻滞 股骨近端防旋型髓内钉手术 麻醉 康复 

分 类 号：R614[医药卫生—麻醉学]