轻比重腰麻与超声引导神经阻滞用于老年髋部骨折手术的效果及对患者血流动力学及应激反应的影响  

Effects of hypobaric spinal anesthesia and ultrasound-guided nerve block on elderly patients undergoing hip fractures surgery and their influence on hemodynamics and stress response

作　　者：李飞鹏 段百杰 Li Feipeng;Duan Baijie(Department of Intervention,Northwest University First Hospital,Xi’an 710000,China;Department of Surgery and Anesthesia,Hancheng People’s Hospital,Hancheng 715400,China)

机构地区：[1]西北大学第一医院介入科,西安710000 [2]韩城市人民医院手术麻醉科,韩城715400

出　　处：《中国实用医刊》2024年第12期24-27,共4页Chinese Journal of Practical Medicine

摘　　要：目的比较轻比重腰麻与超声引导神经阻滞用于老年髋部骨折手术的效果及对患者血流动力学及应激反应的影响。方法队列研究。抽取2021年1月至2023年1月西北大学第一医院收治的120例老年髋部骨折手术患者,按随机数字表法分为对照组和观察组,每组60例。对照组术中采用超声引导神经阻滞,观察组术中采用轻比重腰麻。比较两组麻醉前、术毕时血流动力学[平均动脉压(MAP)、心率]及应激反应[血清皮质醇、儿茶酚胺(CA)];比较两组运动、感觉阻滞时间。结果麻醉前,两组MAP、心率比较差异未见统计学意义(P>0.05);术毕时,观察组MAP、心率高于对照组(P<0.05)。麻醉前,两组血清皮质醇、CA水平比较差异未见统计学意义(P>0.05);术毕时,观察组血清皮质醇、CA水平低于对照组(P<0.05)。观察组运动、感觉阻滞的起效时间、完善时间、持续时间均短于对照组(P均<0.05)。结论与超声引导神经阻滞相比,轻比重腰麻对老年髋部骨折手术患者血流动力学及应激反应的影响较小,且运动、感觉阻滞的起效时间、完善时间、持续时间更短。Objective To compare the effects of hypobaric spinal anesthesia and ultrasound-guided nerve block on elderly patients undergoing hip fractures surgery,and their influence on hemodynamics and stress response.Methods A total of 120 elderly patients who underwent hip fractures surgery in Northwest University First Hospital from January 2021 to January 2023 were selected for the cohort study.And they were divided into a control group and an observation group by random number table method,with 60 cases in each group.The control group received ultrasound-guided nerve block during surgery,and the observation group received hypobaric spinal anesthesia during surgery.The hemodynamics,including mean arterial pressure(MAP)and heart rate,and stress response assesesd by serum cortisol and catecholamine(CA)were compared between the two groups before anesthesia and at the end of surgery.The motor and sensory block time of the two groups were compared.Results There was no statistically significant difference in MAP and heart rate between the two groups before anesthesia(P>0.05);the MAP and heart rate of the observation group were higher than those of the control group at the end of surgery(P<0.05).There was no statistically significant difference in levels of cortisol and CA between the two groups before anesthesia(P>0.05);the levels of cortisol and CA in the observation group were lower than those in the control group at the end of surgery(P<0.05).The onset time,improvement time,and duration of motor and sensory block in the observation group were shorter than those in the control group(all P<0.05).Conclusions Hypobaric spinal anesthesia has less impact on hemodynamics and stress response in elderly patients undergoing hip fractures surgery compared with ultrasound-guided nerve block.The onset time,improvement time,and duration of motor and sensory block induced by hypobaric spinal anesthesia are shorter.

关 键 词：髋部骨折 轻比重腰麻 神经阻滞 血流动力学 应激反应 

分 类 号：R614[医药卫生—麻醉学]