摘要
目的探讨超声引导改良高位髂筋膜阻滞联合轻比重蛛网膜下腔麻醉在老年髋部骨折手术中的应用效果。方法回顾性分析2023年5月至2024年2月莆田九十五医院收治的81例接受老年髋部骨折手术治疗患者的临床资料,按照不同麻醉方法分为观察组(41例)与对照组(40例),观察组采用超声引导下的改良高位髂筋膜阻滞联合轻比重蛛网膜下腔麻醉方法,对照组采用罗哌卡因等比重腰硬联合麻醉方法。比较两组患者的麻醉效果、麻醉前后心率与平均动脉压情况、麻醉后的各项指标评分、不同时间点的静息与运动状态视觉模拟评分法(VAS)、术后的并发症发生率。结果观察组感觉阻滞见效、感觉阻滞成功、运动阻滞起效、运动阻滞成功时间短于对照组,差异有统计学意义(P<0.05)。两组患者麻醉前的心率与平均动脉压比较,差异无统计学意义(P>0.05);观察组麻醉后1 h、麻醉结束时心率与平均动脉压高于对照组,差异有统计学意义(P<0.05)。观察组麻醉后患肢制动下VAS评分、患肢股四头肌等长收缩下的VAS评分低于对照组,差异有统计学意义(P<0.05)。两组患者阻滞操作前静息状态下的VAS评分比较,差异无统计学意义(P>0.05);观察组术后2、4、8、24 h静息状态VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组术后4、8、24 h运动状态VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组术后的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论在老年髋部骨折手术中采用超声引导改良高位髂筋膜阻滞联合轻比重蛛网膜下腔麻醉具有较高的应用价值,可获得较为理想的麻醉效果,能够稳定心率与平均动脉压,还利于减轻患者的疼痛感受,且降低患者的术后并发症发生率,值得推广。
Objective To explore the application effect of ultrasound-guided modified high iliofascial block combined with light specific gravity subarachnoid anesthesia in hip fracture surgery in the elderly.Methods A retrospective analysis was conducted on the clinical data of 81 elderly patients who underwent hip fracture surgery in Putian 95th Hospital from May 2023 to February 2024,they were divided into the observation group(41 cases)and the control group(40 cases)according to different anesthesia methods.The observation group was treated with ultrasound-guided modified high iliofascial block combined with light specific gravity subarachnoid anesthesia,the control group was given combined spinal-epidural anesthesia with equal specific gravity of Ropivacaine.The anesthesia effects,heart rate and mean arterial pressure before and after anesthesia,scores of various indicators after anesthesia,visual analogue scale(VAS)of rest and exercise status at different time points,and the incidence of postoperative complications of the two groups of patients were compared.Results The the onset time of sensory block,the success time of sensory block,the onset time of motor block and the success time of motor block in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in the heart rate and mean arterial pressure before anesthesia between the two groups of patients(P>0.05).The heart rate and mean arterial pressure of the observation group 1 hour after anesthesia and at the end of anesthesia were higher than those of the control group,and the differences were statistically significant(P<0.05).The VAS scores of the affected limb under immobilization and the quadriceps femoris under isometric contraction after anesthesia in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the VAS scores at rest before the block operation between the two groups of patients(P>0.05).The VAS scores of the observation group at rest at 2,4,8,and 24 hours after the operation were lower than those of the control group,and the differences were statistically significant(P<0.05).The VAS scores of the exercise status of the observation group at 4,8,and 24 hours after the operation were lower than those of the control group,and the differences were statistically significant(P<0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The application of ultrasound-guided modified high iliofascial block combined with light specific gravity subarachnoid anesthesia in hip fracture surgery in the elderly has high application value.It can achieve a relatively ideal anesthetic effect,stabilize heart rate and mean arterial pressure,help reduce the pain perception of patients,and lower the incidence of postoperative complications of patients.It is worthy of promotion.
作者
朱文涛
胡贵
陈秀霞
陈朝华
ZHU Wentao;HU Gui;CHEN Xiuxia;CHEN Chaohua(Department of Anesthesiology,Putian 95th Hospital,Fujian Province,Putian351100,China)
出处
《中国当代医药》
2025年第33期71-76,共6页
China Modern Medicine
关键词
超声引导
改良高位髂筋膜阻滞
轻比重蛛网膜下腔麻醉
老年髋部骨折
Ultrasound-guided
Modified high iliac fascia block
Light specific gravity subarachnoid anesthesia
Hip fracture in the elderly
