摘要
目的对比评估腰硬联合麻醉与股神经联合股外侧皮神经阻滞麻醉在高龄患者髋部骨折手术中的效果。方法选取2022年3月—2024年3月于连云港市第一人民医院接受髋部骨折手术治疗的140例高龄患者作为研究对象。按随机数字表法分为股神经联合股外侧皮神经阻滞麻醉组(试验组)和腰硬联合麻醉组(对照组),每组70例。对比两组不同时间段血流动力学、感觉和运动阻滞持续时间、疼痛状况、认知功能、血清水平和并发症的发生情况。结果T_(1)、T_(2)、T_(3)时刻,试验组平均动脉压(MAP)、心率(HR)均高于对照组(P<0.05);T_(1)、T_(2)、T_(3)时刻,对照组MAP均低于本组T_(0)时刻(P<0.05),两组血氧饱和度高于本组T_(0)时刻,HR低于本组T_(0)时刻(P<0.05);试验组的感觉和运动阻滞持续时间的起效时间、完善时间和持续时间均长于对照组(P<0.05);术后6 h、12 h、24 h试验组视觉模拟量表(VAS)评分均低于对照组,简易智力状态检查法(MMSE)评分均高于对照组(P<0.05);术后12 h、24 h,两组的VAS评分、MMSE评分均高于本组术后6 h(P<0.05);试验组手术前后白细胞介素-6(IL-6)、β-淀粉样蛋白1-40(Aβ1-40)、S100β的差值低于对照组(P<0.05);试验组并发症总发生率低于对照组(P<0.05)。结论股神经联合股外侧皮神经阻滞麻醉在高龄髋部骨折术中,相较于腰硬联合麻醉,能有效延长阻滞时间,减少术后疼痛,维持更稳定的血流动力学参数,改善术后认知功能,降低并发症发生率,具有明显的临床优势。
Objective To evaluate the comparative effects of combined spinal-epidural anesthesia and femoral nerve combined with lateral femoral cutaneous nerve block anesthesia in elderly hip fracture surgery.Methods A total of 140 elderly patients who underwent hip fracture surgery at the First People's Hospital of Lianyungang City from March 2022 to March 2024 were selected and randomly divided into two groups using a random number table:the experimental group(femoral nerve combined with lateral femoral cutaneous nerve block anesthesia,n=70)and the control group(combined spinal-epidural anesthesia,n=70).Hemodynamics at different time points,duration of sensory and motor block,postoperative pain,cognitive function,serum levels,and complication rates were compared between the two groups.Results At T_(1),T_(2)and T_(3),MAP and HR in the test group were higher than those in the control group(P<0.05);at T_(1),T_(2)and T_(3),MAP in the control group was lower than that at T_(0)in this group(P<0.05),oxygen saturation in the two groups was higher than that at T_(0)in this group,HR was lower than that at T_(0)in this group(P<0.05);the onset time,perfection time and duration of sensory and motor block duration in the test group were longer than those in the control group(P<0.05);at 6 h,12 h and 24 h after operation,the VAS score of the experimental group was lower than that of the control group,and the MMSE score was higher than that of the control group(P<0.05);at 6 h,12 h and 24 h after operation,VAS score and MMSE score in the two groups were higher than those at 6h after operation in this group(P<0.05);the differences of IL-6,Aβ1-40 and S100βbefore and after operation in the test group were lower than those in the control group(P<0.05);the total incidence of complications in the test group was lower than that in the control group(P<0.05).Conclusion Femoral nerve combined with lateral femoral cutaneous nerve block anesthesia in elderly hip fracture surgery,compared with combined spinal-epidural anesthesia,can effectively prolong the block time,reduce postoperative pain,maintain more stable hemodynamic parameters,improve postoperative cognitive function,reduce the incidence of complications,with obvious clinical advantages.
作者
孙静
单娟娟
秦苗苗
刘乃和
Sun Jing;Shan Juanjuan;Qin Miaomiao;Liu Naihe(Department of Anesthesiology,First People's Hospital of Lianyungang City,Lianyungang 222000)
出处
《国际老年医学杂志》
2025年第4期445-450,共6页
International Journal of Geriatrics
基金
江苏省自然科学基金面上项目(BK20231246)。
关键词
腰硬联合麻醉
股神经阻滞
股外侧皮神经阻滞
髋部骨折
手术恢复
Combined spinal-epidural anesthesia
Femoral nerve block
Lateral femoral cutaneous nerve block
Hip fracture
Surgical recovery
