摘要
目的:探究超声定位辅助腰-硬联合麻醉在下肢骨折中的应用价值.方法:选取2020年7月至2022年7月在解放军联勤保障部队第九〇一医院行手术治疗的80例下肢骨折患者,按照随机数表法将其分为对照组和观察组,每组40例.对照组给予超声下硬膜外麻醉,观察组给予超声下腰-硬联合麻醉.比较两组患者利多卡因用量、麻醉阻滞时间、麻醉起效时间和追加止痛药用量,比较舒张压(DBP)、收缩压(SBP)及心率(HR)等生命体征的变化情况,以及血栓弹力图、麻醉效果及不良反应发生情况.结果:观察组患者利多卡因用量、麻醉阻滞时间、麻醉起效时间及追加止痛药用量明均显高于对照组,差异有统计学意义(t=8.657、23.483、12.785、16.600,P＜0.05).两组患者麻醉前、麻醉后30 min及麻醉结束后DBP、SBP、HR、凝血综合指数(CI)、反应时间(R值)、血细胞凝集块形成时间(K值)及不良反应发生率比较差异均无统计学意义(P＞0.05);与麻醉前、麻醉后30 min相比,两组麻醉结束后α角明显升高(t=6.564、5.783,P＜0.05);观察组麻醉结束后血凝块力学强度(G值)、描记图最大振幅(MA)明显降低,差异有统计学意义(t=8.480、4.236,P＜0.05);对照组G值、MA比较无明显差异(P＞0.05).观察组总有效率为97.50%,明显高于对照组的80.00%,差异有统计学意义(x2=4.507,P＜0.05).结论:下肢骨折患者使用超声定位辅助腰-硬联合麻醉可有效减少麻醉药用量,阻滞快且起效快,对循环功能影响小不易形成高凝状态,临床麻醉效果更好.
Abstract
Objective:To explore application value of combined spinal-epidural anesthesia under the assistant of ultrasound location on lower limb fractures.Methods:A total of 80 patients with lower limb fractures who underwent surgical treatment at the 901th Hospital of the PLA Joint Service Support Force from July 2020 to July 2022 were selected,and they were divided into a control group and an observation group according to the random number table method,with 40 cases in each group.The control group received epidural anesthesia under ultrasound,and the observation group received the combined lumbar-epidural anesthesia under ultrasound.The lidocaine dosage,anesthetic block time,anesthesia onset time and dosage of additional analgesic,as well as the changes in vital signs such as diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR),between the two groups of patients were compared.In addition,the thrombelastogram,anesthetic effects and occurrence of adverse reactions also were compared between two groups.Results:The lidocaine dosage,anesthetic block time,anesthesia onset time and dosage of additional analgesic of the observation group were significantly higher than those in the control group,and the differences were statistically significant(t=8.657,23.483,12.785,16.600,P<0.05),respectively.There were no statistically significant differences in DBP,SBP,HR,comprehensive coagulation index(CI),reaction time(R),formation time of blood cell agglutination(K)and incidence of adverse reactions between two groups before anesthesia,at the 30th minute after anesthesia and after the end of anesthesia(P>0.05).Compared with α angle before anesthesia and at the 30th minute after anesthesia,the α angles of the two groups increased significantly after anesthesia(t=6.564,5.783,P<0.05),respectively.The mechanical strength(G)of the blood clot and the maximum amplitude(MA)of chromatogram of the observation group were significantly reduced after completed anesthesia,and the differences of them were statistically significant(t=8.480,4.236,P<0.05),respectively.There were no significant differences between G and MA in the control group(P>0.05).The total effective rate of the observation group was 97.50%,which was significantly higher than 80.00% of the control group,and the difference was statistically significant(x2=4.507,P<0.05).Conclusion:The combined spinal-epidural anesthesia under the assistant of ultrasound location can effectively reduce the amount of anesthetics in patients with lower limb fracture,which has fast block and effect.In addition,it has little influence on circulatory function,and it is less likely to form a hypercoagulable state.It has better clinical anesthesia effect.
基金项目
安徽省卫生健康委员会科研项目(2020SEYL017)
国家科技期刊平台
NSTL
维普
万方数据