超声引导下高位髂筋膜阻滞对老年股骨骨折手术患者麻醉效果的影响  

Anesthesia effect of ultrasound-guided high fascia iliac compartment block on the elderly patients with femur fracture surgery

作　　者：葛军超 程学忠 寇海洋 Ge Jun-chao;Cheng Xue-zhong;Kou Hai-yang(Department of Anesthesiology,Yanling People's Hospital,Xuchang 461200,Henan,China;Department of Anesthesiology,Xuchang Central Hospital,Xuchang 461000,Henan,China)

机构地区：[1]鄢陵县人民医院麻醉科,河南许昌461200 [2]许昌市中心医院麻醉科,河南许昌461000

出　　处：《四川生理科学杂志》2024年第12期2617-2619,2654,共4页

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20221025)。

摘　　要：目的:探讨超声引导下高位髂筋膜阻滞(Fascia iliac compartment block,FICB)对老年股骨骨折手术患者麻醉效果的影响。方法:回顾性选取鄢陵县人民医院2022年1月至2023年10月行股骨骨折手术的89例老年患者,按麻醉方案不同分为全麻组(n=43)和FICB复合全麻组(n=46)。比较两组不同时间点生命体征指标、应激反应指标、疼痛程度、麻醉效果、麻醉药物用量及不良反应。结果:手术开始后5 min时,FICB复合全麻组心率低于全麻组(P<0.05);可视喉镜插管时、手术开始后5 min时,FICB复合全麻组平均动脉压低于全麻组(P<0.05);手术进行30 min时,FICB复合全麻组血浆肾素活性、去甲肾上腺素、醛固酮水平均低于全麻组(P<0.05);术后2 h、6 h、12 h时,FICB复合全麻组运动/静息状态视觉模拟评分法评分均低于全麻组(P<0.05);FICB复合全麻组丙泊酚、瑞芬太尼用量及镇痛泵总按压次数均少于全麻组,痛觉阻滞起效时间、拔管时间、麻醉苏醒时间均短于全麻组,痛觉阻滞持续时间长于全麻组(P<0.05);两组不良反应总发生率相比,无显著差异(P>0.05)。结论:超声引导下高位FICB复合全麻能有效维持老年股骨骨折患者术中生命体征平稳,减轻术中应激,提升麻醉效果,减少镇静、镇痛药用量,且安全性较高。Objective:To explore the anesthesia effect of ultrasound-guided fascia iliac compartment block(FICB)on the elderly patients with femoral fracture surgery.Methods:A total of 89 elderly patients who underwent femoral fracture surgery in Yanling People's Hospital from Jan.2022 to Oct.2023 were retrospectively selected and divided into general anesthesia group(n=43)and FICB combined group(n=46)according to different anesthesia programs.The indexes of vital signs,stress response,pain degree,anesthetic effect,anesthetic drug dosage and adverse reactions were compared at different time points between the two groups.Results:At 5 minutes after operation,the heart rate in FICB combined group was lower than that in general anesthesia group,at visual laryngoscope intubation and 5 minutes after operation,the mean arterial pressure was lower than that in general anesthesia group(P<0.05).After 30 minutes of operation,levels of plasma renin activity,norepinephrine and aldosterone in FICB combined group were lower than those in general anesthesia group(P<0.05).At 2 hours,6 hours and 12 hours after surgery,the visual analogue scale score in FICB combined group was lower than that in general anesthesia group(P<0.05).The dosage of propofol and remifentanil,the total number of analgesic pump in FICB combined group were lower than those in general anesthesia group,the onset time of pain block,extubation time and anesthesia recovery time were shorter than those in general anesthesia group,and the duration time of pain block was longer than that in general anesthesia group(P<0.05).The total incidence of adverse reactions had no difference between the two groups(P>0.05).Conclusion:Ultrasound-guided FICB combined general anesthesia can effectively maintain the stability of operative vital signs in elderly patients with femoral fracture,alleviate the intraoperative stress,improve the anesthetic effect,and reduce the dosage of sedation and analgesia,and is safe and reliable.

关 键 词：股骨骨折 全身麻醉 高位髂筋膜阻滞 超声引导 

分 类 号：R614[医药卫生—麻醉学]