摘要
目的 探讨超声引导下髋关节囊周神经丛(PENG)阻滞联合喉罩全麻对老年患者行股骨颈骨折闭合复位内固定术的麻醉效果.方法 选取行股骨颈骨折闭合复位内固定术的100 例老年患者为研究对象,随机分为对照组、观察组两组,每组50 例.对照组采用喉罩全麻,观察组采用超声引导下PENG阻滞联合喉罩全麻,比较两组静息和咳嗽状态视觉模拟评分(VAS),围术期血流动力学,血清应激反应指标以及麻醉药用量及术后恢复情况.结果 术后2、12、24 h,观察组静息状态和咳嗽状态下VAS评分均低于对照组,差异均有统计学意义(t分别=4.20、12.35、14.65、6.49、15.26、10.08,P均＜0.05).观察组手术开始后40 min及麻醉苏醒时肾上腺素(AD)和内皮素(ET)水平低于对照组,差异均有统计学意义(t分别=5.87、2.96、2.61、2.05,P均＜0.05).观察组麻醉后5、60 min 平均动脉压(MAP)水平高于对照组,心率(HR)低于对照组,差异均有统计学意义(t分别=-5.33、-4.29、3.87、3.82,P均＜0.05).观察组舒芬太尼、丙泊酚、顺阿曲库铵使用剂量低于对照组,差异均有统计学意义(t分别=7.85、5.92、7.07,P均＜0.05).观察组首次下床活动时间早于对照组,住院时间短于对照组,术后并发症发生率低于对照组,差异均有统计学意义(t分别=18.10、5.57,χ2=4.33,P均＜0.05).结论 实施股骨颈骨折闭合复位内固定术的老年患者应用PENG阻滞联合喉罩全麻能有效镇痛和减轻围术期应激反应,还可减少术中麻醉药用量和术后并发症发生率,改善术后苏醒质量.
Abstract
Objective To explore the anesthesia effect of ultrasound-guided hip pericapsular nerve group(PENG)block combined with laryngeal mask anesthesia on elderly patients undergoing closed reduction and internal fixation sur-gery for femoral neck fractures.Methods A study was conducted on 100 elderly patients who underwent closed reduc-tion and internal fixation surgery for femoral neck fractures.They were randomly divided into a control group and an ob-servation group,with 50 cases in each group.The control group was subjected to general laryngeal mask anesthesia,and the observation group was treated with ultrasound-guided PENG block combined with general laryngeal mask anesthesia to compare the visual analogue score(VAS),perioperative hemodynamics,serum stress response indexes,anesthetic dosage and postoperative recovery of the two groups.Results At 2,12,and 24 hours after surgery,the VAS scores of the observation group were lower than those of the control group in both resting and coughing states(t=4.20,12.35,14.65,6.49,15.26,10.08,P＜0.05).The levels of adrenaline(AD)and endothelin(ET)in the observation group were lower than those in the control group at 40 minutes after surgery and during anesthesia awakening,and the differences were statistically significant(t=5.87,2.96,2.61,2.05,P＜0.05).The average arteri-al pressure(MAP)level in the observation group was higher than that in the control group at 5 min-utes and 60 minutes after anesthesia,while the heart rate(HR)was lower than that in the control group,and the differences were statistically significant(t=-5.33,-4.29,3.87,3.82,P＜0.05).The dosage of sufentanil,propofol,and cisatracurium used in the observation group were lower than those in the control group,and the differences were statistically significant(t=7.85,5.92,7.07,P＜0.05).The observation group had a shorter time of getting out of bed and hospital stay than the control group,and the incidence of postoperative complications was lower than that of the control group,with statistical significance(t=18.10,5.57,χ2=4.33,P＜0.05).Conclusion The application of PENG block combined with laryngeal mask general anesthesia in elderly pa-tients undergoing closed reduction and internal fixation of femoral neck fracture can effectively relieve analgesia and re-duce perioperative stress,reduce the amount of intraoperative anesthetic drugs and incidence of postoperative complica-tions,and improve the quality of postoperative awakening.
维普
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