股神经联合股外侧皮神经阻滞麻醉与腰硬联合麻醉在老年危重症患者下肢骨折手术中的应用效果比较  

Comparison of the effect of femoral nerve combined with lateral femoral cutaneous nerve block anesthesia and lumbo-epidural anesthesia in the operation of lower extremity fracture in elderly critically ill patients

作　　者：柯琳 何婧婧 KE Lin;HE Jingjing(Department of Anesthesiology,Zhangzhou Hospital Affiliated to Fujian Medical University,Fujian Province,Zhangzhou363000,China)

机构地区：[1]福建医科大学附属漳州市医院麻醉科,福建漳州363000

出　　处：《中国当代医药》2024年第26期89-92,共4页China Modern Medicine

摘　　要：目的探讨股神经联合股外侧皮神经阻滞麻醉与腰硬联合麻醉应用于老年危重症患者下肢骨折手术中的应用效果。方法选取2022年6月至2023年6月至福建医科大学附属漳州市医院骨科就诊的100例老年危重症下肢骨折手术患者作为研究对象,采用随机数字表法将其分为对照组(50例)和观察组(50例),对照组采用腰硬联合麻醉方法,观察组采用股神经+股外侧皮神经阻滞麻醉方法,比较两组麻醉前(T_(0))、麻醉即刻(T_(1))、麻醉后30 min(T_(2))、术毕即刻(T_(3))的血流动力学指标、氧化应激指标、不良反应。结果两组T_(0)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)水平比较,差异无统计学意义(P>0.05),观察组T_(1)~T_(3)时间的SBP、DBP、MAP水平高于对照组,差异有统计学意义(P<0.05);两组T_(0)时间点的去甲肾上腺素(NE)、丙二醛(MDA)水平比较,差异无统计学意义(P>0.05),观察组T_(1)~T_(3)时间的NE、MDA水平低于对照组,差异有统计学意义(P<0.05);观察组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论股神经联合股外侧皮神经阻滞麻醉方式,用于老年危重症患者下肢骨折手术中,便于降低氧化应激反应,稳定血流动力学指标水平,安全性较高。Objective To investigate the effect of femoral nerve+lateral femoral cutaneous nerve block anesthesia and combined epidural anesthesia in the operation of lower extremity fracture in elderly patients with critical illness.Methods A total of 100 elderly patients with critical lower extremity fracture who visited the Department of Orthopedics,Zhangzhou Hospital Affiliated to Fujian Medical University from June 2022 to June 2023 were selected as the study objects.They were divided into control group(50 cases)and observation group(50 cases)by random number table method.The control group was given combined epidural anesthesia.Femoral nerve+lateral femoral cutaneous nerve block anesthesia was used in the observation group.The hemodynamic indexes,oxidative stress indexes and adverse reactions of the two groups were compared before anesthesia(T_(0)),immediately after anesthesia(T_(1)),30 min after anesthesia(T_(2))and immediately after surgery(T_(3)).Results The systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP)levels of T_(0) between the two groups had no statistical significance(P>0.05),but the SBP,DBP and MAP levels of T_(1)-T_(3) in the observation group were higher than those in the control group,with statistical significance(P<0.05).There was no statistical significance in the levels of norepinephrine(NE)and malondialdehyde(MDA)between the two groups at T_(0) time point(P>0.05),but the levels of NE and MDA at T_(1)-T_(3) time in the observation group were lower than those in the control group,with statistical significance(P<0.05).The total incidence of adverse reactions in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion The anesthesia method of femoral nerve+lateral femoral cutaneous nerve block is suitable for lower limb fracture surgery in elderly critically ill patients,which is conducive to reducing oxidative stress response,stabilizing hemodynamic index levels,and has high safety.

关 键 词：老年危重症 下肢骨折手术 腰硬联合麻醉 股神经 股外侧皮神经阻滞麻醉 安全性 

分 类 号：R614[医药卫生—麻醉学]