超声引导下股神经联合坐骨神经阻滞麻醉对老年下肢骨折患者麻醉安全性及血浆皮质醇影响的研究  

Influence of ultrasound-guided femoral nerve combined with sciatic nerve block anesthesia on the safety of anesthesia and plasma cortisol in elderly patients with lower limb fracture

作　　者：徐庆华 李萌 XU Qing-hua(Yongcheng Coal Group General Hospital,Yongcheng 476600,Henan,China)

机构地区：[1]永城市永煤集团总医院麻醉科,河南永城476600 [2]河南大学第一附属医院麻醉与围术期医学科,河南开封475000

出　　处：《牡丹江医学院学报》2024年第4期23-26,共4页Journal of Mudanjiang Medical University

摘　　要：目的探讨对开展手术治疗的老年下肢骨折患者采用超声引导下股神经联合坐骨神经阻滞麻醉对麻醉安全性及血浆皮质醇的影响。方法通过随机数字表法将我院于2020年10月至2022年11月收治的老年下肢骨折患者88例分为两组(n=44)。两组均开展下肢骨折手术治疗,对照组和观察组分别采用腰硬联合麻醉和超声引导下股神经联合坐骨神经阻滞麻醉。比较两组相关临床指标、T0、T1、T2的MAP和HR、术后2 h、6 h、12 h、24 h疼痛(VAS评分)以及围术期血浆皮质醇水平。结果与对照组相比较,观察组感觉、运动神经阻滞起效、术后恢复排尿、下肢运动恢复时间均较短(P<0.05);与T 0时相比较,两组T 1、T 2时MAP水平下降,HR水平提升,且与对照组相比较,观察组MAP水平较低,HR水平较高(P<0.05);与对照组相比较,观察组术后2 h、6 h、12 h、24 h VAS评分均较低(P<0.05);术后2 h、术后第3天两组血浆皮质醇水平相较于麻醉前均有所提高,但与对照组相比较,观察组血浆皮质醇水平提升幅度较小(P<0.05)。结论对进行手术的老年下肢骨折患者采用超声引导下股神经联合坐骨神经阻滞麻醉,能起到良好的麻醉效果的同时对患者血流动力学水平的影响较小,具有较高的安全性,同时在稳定患者围术期血浆皮质醇水平,降低患者术后疼痛方面具有积极意义。Objective To investigate the effects of ultrasound-guided femoral nerve combined with sciatic nerve block anesthesia on the safety of anesthesia and plasma cortisol in elderly patients with lower limb fractures undergoing surgical treatment.Methods 88 elderly patients with lower extremity fracture admitted to our hospital from October 2020 to November 2022 were divided into two groups by random number table method(n=44).Both groups underwent surgical treatment for lower extremity fracture.The control group and observation group were given combined epidural anesthesia and ultrasound-guided femoral nerve combined sciatic nerve block anesthesia,respectively.The relevant clinical indicators,MAP and HR of T0,T1 and T2,pain(VAS score)at 2h,6h,12h and 24h after surgery and perioperative plasma cortisol levels were compared between the two groups.Results Compared with the control group,the effect of sensory and motor nerve block,postoperative urination and lower limb movement recovery time in observation group were shorter(P<0.05).Compared with T0,MAP level decreased and HR level increased at T1 and T2,and compared with control group,MAP level was lower and HR level was higher in observation group(P<0.05).Compared with the control group,VAS scores in the observation group were lower at 2 h,6 h,12 h and 24 h after surgery(P<0.05).Compared with before anesthesia,plasma cortisol levels in both groups were increased 2 hours after surgery and 3 days after surgery,but compared with the control group,the increase of plasma cortisol levels in the observation group was smaller(P<0.05).Conclusion The use of ultrasound-guided femoral nerve combined with sciatic nerve block anesthesia for elderly patients with lower extremity fractures undergoing surgery can have a good anesthetic effect,little impact on the hemodynamic level of patients,higher safety,and positive significance in stabilizing the perioperative plasma cortisol level and reducing the postoperative pain of patients.

关 键 词：老年 下肢骨折 超声引导 股神经阻滞麻醉 坐骨神经阻滞麻醉 安全性 

分 类 号：R614.4[医药卫生—麻醉学]