The effect of ultrasound-guided high-position femoral nerve block in elderly patients at the time of changing position before combined spinal-epidural anesthesia
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摘要: 目的:观察不同镇痛方法在髋部骨折手术麻醉前体位变动的镇痛效果。方法:选择ASA分级Ⅱ~Ⅲ级择期行在腰硬联合麻醉下行髋部骨折手术患者60例,按随机数字表法分为3组:高位股神经阻滞组(N组)、静脉镇痛组(P组)及对照组(C组),每组20例。分别记录各组入室10 min(T1)、镇痛处理前即刻(T1)、镇痛处理后15 min(T2)、体位变动即刻(T3)、摆好麻醉体位时(T4)、维持麻醉体位1 min(T5)的MAP 和HR、VAS评分、呼吸抑制(呼吸次数<10次/min)的发生率、SPO2,记录腰硬联合麻醉穿刺的成功率及穿刺的时间,评估患者配合程度及满意度。结果:N组的疼痛视觉模拟评分(VAS评分)、MAP 和HR于T2、T3、T4、T5均显著低于P组及C组(P<0.05),P组呼吸抑制的发生率大于N组和C组,腰硬联合麻醉穿刺的成功率N组大于P组及C组。结论:超声引导下高位股神经阻滞可以明显缓解老年患者髋部骨折手术麻醉前体位变动疼痛,血流动力学更平稳。Abstract: Objective:To investigate the application of ultrasound-guided high-position femoral nerve block in elderly patients with hip fracture at the time of changing position before combined spinal-epidural anesthesia.Method:Sixty ASA Ⅱ-Ⅲ patients,who were randomly divided into the three group(N=20):high position femoral nerve block group (group N),intravenous analgesia group (group P),control group (group C).The mean arterial pressure(MAP),heart rate(HR),visual analgesia score (VAS),respiratory depression and SPO2 were recorded at the point of 10 min after entering the operation room(T0),the time before anesthesia(T1),15 min after analgesia (T2),the immediate time at changing of position (T3),at the time of finishing anesthesia position(T4) and maintaining anesthesia position 1 min (T5).The succeed rate of combined spinal-epidural anesthesia,the punctured time,the cooperation and the satisfaction of patients were recorded.Result:Compared with group P and group C,MAP and HR of group N decreased significantly at T2-T5 (P<0.05).Respiratory depression rate was much higher in group P (P<0.05).Compared with group P and group C,the succeed rate of combined spinal-epidural was much higher in group N.Conclusion:Ultrasound-guided high position femoral nerve block can significantly release the pain at the time of changing position before combined spinal-epidural anesthesia in elderly patients with hip fracture surgery and the hemodynamic was much more stable.
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Key words:
- femoral nerve block /
- hip fracture /
- change of position /
- analgesia
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