仰卧位腰大肌短轴联合腰丛神经阻滞在老年股骨粗隆间骨折患者中的应用效果及对镇痛、镇静的影响  

Effect of short axis of psoas major muscle combined with lumbar plexus block in supine position in elderly patients with intertrochanteric fracture of femur and its effects on analgesia and sedation

作　　者：折甜甜 刘文雄 章平 SHE Tian-tian;LIU Wen-xiong;ZHANG Ping(Department of Anesthesiology,Xidian Group Hospital,Xi'an Shaanxi 710077,China;Department of Anesthesiology,Xi'an Gaoxin Hospital,Xi'an Shaanxi 710000,China)

机构地区：[1]西电集团医院麻醉科,陕西西安710077 [2]西安高新医院麻醉科,陕西西安710000

出　　处：《临床和实验医学杂志》2025年第4期442-446,共5页Journal of Clinical and Experimental Medicine

基　　金：陕西省自然科学基础研究计划项目(编号:2024JC-YBMS-781)。

摘　　要：目的分析仰卧位腰大肌短轴联合腰丛神经阻滞在老年股骨粗隆间骨折患者中的应用效果及对镇痛、镇静的影响。方法前瞻性选取2021年10月至2024年6月西电集团医院收治的180例老年股骨粗隆间骨折患者,按照随机数字表法将其分为腰丛神经组与联合组,各90例。腰丛神经组术前实施常规腰从神经阻滞,联合组实施仰卧位腰大肌短轴联合腰丛神经阻滞。比较两组患者阻滞成功率,术中[入室时(T_(0)),手术开始即刻(T_(1)),切口缝合时(T_(2)),手术结束后30min(T_(3))]心率、平均动脉压波动情况,并在术后2、6、12、24 h采用视觉模拟评分法(VAS)、警觉/镇静观察评分法(OAA/S)评价两组镇痛、镇静效果,以及比较两组并发症(硬膜外腔感染、局部组织炎症反应、硬膜外血肿、神经损伤等)发生率。结果联合组闭孔神经、股外侧皮神经、股神经阻滞成功率与腰丛神经组比较,差异均无统计学意义(P>0.05)。两组组内T_(0)、T_(1)、T_(2)、T_(3)的心率、平均动脉压呈现先降低后升高趋势,差异均有统计学意义(P<0.05);但两组组间T_(0)、T_(1)、T_(2)、T_(3)各时间点的心率、平均动脉压比较,差异均无统计学意义(P>0.05)。两组组内术后2、6、12、24 h的VAS评分呈现先升高后降低趋势,差异均有统计学意义(P<0.05)。术后2 h,两组患者的VAS评分比较,差异无统计学意义(P>0.05);联合组患者术后6、12、24 h VAS评分分别为(3.12±0.57)、(3.33±0.53)、(2.57±0.27)分,均低于腰丛神经组[(3.81±0.46)、(4.17±0.64)、(2.82±0.35)分],差异均有统计学意义(P<0.05)。两组组内术后2、6、12、24 h的OAA/S评分呈逐渐上升趋势,差异均有统计学意义(P<0.05)。但术后2、6、12、24 h,联合组与腰丛神经组患者OAA/S评分比较,差异均无统计学意义(P>0.05)。联合组硬膜外阻滞并发症总发生率为1.11%,低于腰丛神经组(7.78%),差异有统计学意义(P<0.05)。结论与单纯腰丛神Objective To analyze the effect of short axis of psoas major muscle combined with lumbar plexus block in supine position in elderly patients with intertrochanteric fractures of the femur,and its impact on analgesia and sedation.Methods A total of 180 elderly patients with intertrochanteric fracture of femur admitted to Xidian Group Hospital from October 2021 to June 2024 were prospectively selected and divided into the lumbar plexus group and the combined group according to the random number table method,with 90 cases in each group.The lumbar plexus group received routine lumbar nerve block before surgery,while the combined group received short axis of psoas major muscle combined with lumbar plexus block in supine position.The success rate of block,the fluctuation of heart rate and mean arterial pressure during operation[at the time of entry(T_(0)),immediately at the start of surgery(T_(1)),at the time of incision closure(T_(2)),and 30 min after surgery(T_(3))]were compared between the two groups.The analgesic and sedative effects of the two groups were evaluated by visual analogue scale(VAS)and alertness/sedation observation score(OAA/S)at 2,6,12 and 24 h after operation,and the incidence of complications(epidural infection,local tissue inflammatory reaction,epidural hematoma,nerve injury,etc.)were compared between the two groups.Results There were no statistically significant differences in the success rate of block,lateral femoral cutaneous nerve and femoral nerve block between the combined group and the lumbar plexus group(P>0.05).The heart rate and mean arterial pressure of the two groups at T_(0),T_(1),T_(2)and T_(3)showed a trend of decreasing first and then increasing,and the differences were statistically significant(P<0.05),but there were no statistically significant differences in heart rate and mean arterial pressure between the two groups at T_(0),T_(1),T_(2),and T_(3)time points(P>0.05).The VAS scores of the two groups at 2,6,12 and 24 h after operation showed a trend of increasing first and then de

关 键 词：股骨粗隆间骨折 仰卧位 腰大肌短轴 腰丛神经阻滞 老年人 镇痛 镇静 

分 类 号：R614[医药卫生—麻醉学]