摘要
目的评估髂腰肌间隙前路腰丛在强迫体位患者股骨近端手术的应用价值。方法选择2018年5月—2021年7月本院因单侧股骨近端骨折拟行手术治疗患者100例作为研究对象,随机数表法分为观察组和对照组两组,每组各50例。观察组采用髂腰肌间隙前路腰丛阻滞复合骶骨旁侧入路坐骨神经阻滞;对照组选择可耐受侧卧位,采用腰大肌间隙后路腰丛阻滞复合骶骨旁后路坐骨神经阻滞。两组阻滞成功后采用喉罩下静吸复合全身麻醉。观察两组的准备时间、操作时间、股神经、股外侧皮神经、闭孔神经阻滞成功率及起效时间;手术切皮时、切皮后1 min、切皮后10 min的血流动力学变化;停麻醉药物到清醒拔除喉罩时间,阻滞后6 h、12 h、16 h患者视觉模拟评分(VAS),统计两组并发症及发生率。结果观察组在准备及操作时间与对照组有显著差异(P<0.05),明显短于对照组;而阻滞成功率及起效时间两组间无明显统计学差异(P>0.05),切皮后1 min、10 min的血流动力学变化及术后清醒拔除喉罩时间两组间无明显统计学差异(P>0.05);阻滞后6 h、12 h、16 h视觉模拟评分(VAS)两组间无明显统计学差异(P>0.05);两组发生术后恶心呕吐发生率相似,对照组发生局麻药中毒1例。结论髂腰肌间隙前路腰丛阻滞应用于股骨近端手术在麻醉、术后镇痛效果与腰大肌间隙后路腰丛无明显差异,操作难度低且安全性高,特别适合强迫体位患者,值得临床推广。
Objective To evaluate the application value of iliopsoas space anterior lumbar plexus in the proximal femur operation for patients suffered with forced posture.Methods From May 2018 to July 2021,100 patients with unilateral proximal femoral fracture and attempt to receive surgical treatment were selected as study objects,and they were divided into two group according to random number table method,50 cases in each group.Patients in the observation group were treated with anterior lumbar plexus block in the iliopsoas muscle space combined with sciatic nerve block in the lateral sacral approach,and patients in the control group were treated with psoas major muscle space posterior lumbar plexus block combined with sciatic nerve block in the backward sacral approach at tolerant lateral lying position.After successful block,the two groups were treated with intravenous inhalation combined with general anesthesia under laryngeal mask.The preparation time,operation time,success block rate and onset time of femoral nerve,lateral femoral cutaneous nerve and obturator nerve,hemodynamic changes during skin cutting and 1 min and 10 min after skin cutting,the time from stopping narcotic drugs to conscious removal of laryngeal mask,VAS score at 6,12 and 16 h after block,and the complications and incidence of complications of the two groups were observed.Results The preparation and operation time of the observation group were significantly shorter than that of the control group(P<0.05).There was no significant difference in the success rate of block and onset time between the two groups(P<0.05).There was no significant difference in the hemodynamic changes at 1 min and 10 min after skin incision and the time of conscious laryngeal mask removal between the two groups(P<0.05).There was no significant difference in VAS scores between the two groups at 6 h,12 h and 16 h after block(P<0.05).The incidence of postoperative vomiting was similar between the two groups,and 1 case of local anesthetic poisoning occurred in the control group.Conclusions There is no significant difference in anesthesia and postoperative analgesia effects between anterior lumbar plexus block in iliopsoas space and psoas major muscle space posterior lumbar plexus block in proximal femur surgery.It has low operation difficulty and high safety.It is especially suitable for patients in forced posture and is worthy of clinical promotion.
作者
吴泽伟
邹彩霞
钟岳
殷俊
吕波
Wu Zewei;Zou Caixia;Zhong Yue;Yin Jun;Lv Bo(Fuyong people’s hospital,Baoan district,Shenzhen,Guangdong,518103,China)
出处
《齐齐哈尔医学院学报》
2022年第2期129-132,共4页
Journal of Qiqihar Medical University
基金
深圳市宝安区医疗卫生基础研究项目(2019JD185)。
关键词
髂腰肌间隙
腰大肌间隙
腰丛
股骨近端手术
强迫体位
Iliopsoas muscle space
Psoas major muscle space
Lumbar plexus
Proximal femur operation
Forced posture
