依托咪酯复合腰丛-坐骨神经联合阻滞在老年患者股骨上段骨折手术中的效果  

The effect of etomidate combined with lumbar plexus sciatic nerve block in surgery for upper femoral fractures in elderly patients

作　　者：王宿利 王娟[1] 刘颖 Wang Suli;Wang Juan;Liu Ying(Department of Anesthesiology,Huaibei Miner General Hospital,Huaibei 235000,China)

机构地区：[1]淮北矿工总医院麻醉科,淮北235000

出　　处：《中国医师杂志》2024年第5期697-701,706,共6页Journal of Chinese Physician

基　　金：安徽省重点研究和开发计划项目(2104h08020267)。

摘　　要：目的探究依托咪酯复合腰丛-坐骨神经联合阻滞在老年患者股骨上段骨折手术中的效果。方法选取2021年4月至2023年4月淮北矿工总医院收治的64例行股骨上段骨折手术的老年患者作为研究对象,采用随机数字表法分为A组和B组,每组32例,A组予以丙泊酚诱导麻醉+七氟醚持续吸入维持麻醉,B组予以依托咪酯诱导麻醉+持续输注维持麻醉,两组在全麻诱导前均行腰丛-坐骨神经联合阻滞。比较两组手术时间、术后苏醒时间、术中去氧肾上腺素使用情况、围手术期血流动力学指标(心率、舒张压、收缩压),感觉神经阻滞和运动神经阻滞效果,术后认知功能及疼痛程度、不良反应及并发症情况。结果两组患者的手术时间比较差异无统计学意义(P>0.05);A组患者的术后苏醒时间短于B组,去氧肾上腺素使用比例高于B组(均P<0.05)。两组患者麻醉前的心率、舒张压、收缩压比较,差异无统计学意义(均P>0.05);两组患者麻醉15 min后(T2)和手术结束后60 min(T3)时的心率比较,差异无统计学意义(均P>0.05);两组患者T2和T3时的舒张压和收缩压均低于麻醉前(T1)时点,且A组低于B组(均P<0.05)。两组患者的感觉神经阻滞、运动神经阻滞的起效时间和维持时间比较,差异无统计学意义(均P>0.05)。两组患者术后的简易智力状态检查量表(MMSE)评分、视觉模拟量表(VAS)评分均低于术前(P<0.05);且A组术后MMSE评分低于B组(P<0.05)。A组患者术后不良反应及并发症发生率高于B组(P<0.05)。结论在老年患者股骨上段骨折手术中实施依托咪酯复合腰丛-坐骨神经联合阻滞麻醉方法,可有效稳定患者围手术期的血流动力学,减少对术后认知功能的损伤,术中麻醉效果及安全性良好。Objective To investigate the effect of etomidate combined with lumbar plexus sciatic nerve block in the surgery of upper femoral fractures in elderly patients.Methods A total of 64 elderly patients who underwent surgery for upper femoral fractures at the Huaibei Miner General Hospital from April 2021 to April 2023 were selected as the study subjects.They were randomly divided into group A and group B using a random number table method,with 32 patients in each group.Group A received propofol induced anesthesia and continuous inhalation of sevoflurane to maintain anesthesia,while group B received etomidate induced anesthesia and continuous infusion to maintain anesthesia.Both groups underwent lumbar plexus sciatic nerve block before general anesthesia induction.Two groups were compared in terms of surgical time,postoperative recovery time,intraoperative use of epinephrine,perioperative hemodynamic indicators(heart rate,diastolic blood pressure,systolic blood pressure),sensory nerve block,motor nerve block,postoperative cognitive function and pain level,adverse reactions,and complications.Results There was no statistically significant difference in surgical time between the two groups of patients(P>0.05);The postoperative recovery time of group A patients was shorter than that of group B,and the proportion of epinephrine use was higher than that of group B(all P<0.05).There was no statistically significant difference in heart rate,diastolic blood pressure,and systolic blood pressure between the two groups of patients before anesthesia(P>0.05);There was no statistically significant difference in heart rate between the two groups of patients at 15 minutes after anesthesia(T2)and 60 minutes after surgery(T3)(all P>0.05);The diastolic and systolic blood pressure of both groups of patients at T2 and T3 were lower than before anesthesia(T1),and group A was lower than group B(all P<0.05).There was no statistically significant difference in the onset and maintenance time of sensory nerve block and motor nerve block between

关 键 词：股骨骨折 依托咪酯 神经传导阻滞 腰丛 坐骨神经 

分 类 号：R614[医药卫生—麻醉学]