超声引导下腰骶丛神经阻滞联合鼻咽通气道对比联合喉罩在高龄患者股骨近端髓内钉内固定术中的应用

摘要

目的 比较超声引导下腰骶丛神经阻滞联合喉罩置入与联合鼻咽通气道置入在高龄患者股骨近端行抗旋髓内钉内固定术的应用效果.方法 入选中山市中医院2013年7月至2016年11月期间股骨近端骨折拟择期行抗旋髓内钉内固定术的高龄患者42例,采用随机数字表法随机分为两组:神经阻滞联合喉罩组(H组,n=21)和神经阻滞联合鼻咽通气道组(B组,n=21).两组患者在超声引导下行单侧腰丛+骶丛神经阻滞后,H组保留自主呼吸喉罩全麻;B组轻度镇静置入鼻咽通气道,面罩给氧.维持两组患者术中脑电双频指数(BIS)60~75,记录患者手术和麻醉情况以及围手术期并发症情况.采用SPSS 13.0软件进行数据分析,根据数据类型分别采用t检验或Fisher确切概率法比较组间差异.结果 与H组相比,B组患者丙泊酚用量明显减少,低血压发生率降低,血管活性药物使用减少,术后拔除喉罩(鼻咽通气道)时间和住院时间明显缩短(P<0.05).H组患者术后7 d 4例出现肺部感染,其中2例转重症监护室治疗;两组患者术后7 d内的术后认知功能障碍(POCD)发生率差异无统计学意义(P>0.05).结论 与联合喉罩麻醉比较,超声下腰骶丛神经阻滞联合鼻咽通气道用于高龄患者股骨近端抗旋髓内钉内固定术可显著减少术中丙泊酚用量,缩短出院时间,有利于患者术后结局.%Objective To investigate the efficacy of ultra-sound guided lumbar plexus and sciatic plexus block combined laryngeal mask airway or nasopharygeal airway in the elderly patients undergoing proximal femoral nail antirotation.Methods A total of 42 very old patients scheduled for proximal femoral nail antirotation surgery in our hospital from July 2013 to November 2016 were randomly assigned into laryngeal mask airway group (group H) and nasopharyngeal airway group (group B, n=21).After lumbar plexus and sciatic plexus block under the ultra-sound guidance, spontaneous respirations were retained in the patients of group H with laryngeal mask airway, and those of group B were lightly sedated with nasopharyngeal airway.The intraoperative bispectral index (BIS) was maintained at 60-75.The surgery, anesthesia and peri-operative complications were observed and compared between the 2 groups.SPSS statistics 13.0 was used to analyze the data.The difference were compared with t test or Fisher exact test respectively.ResultsCompared with the group H, group B had lower dosages of propofol and vasoactive agents, lower incidence of hypotension, shorter period from end of surgery to extubation, and shorter length of hospital stay.There were 4 patients having pulmonary infection within 7 days after operation, and 2 of them were transferred to Intensive Care Unit.The incidence rate of postoperative cognitive dysfunction (POCD) was not statistically different between 2 groups (P>0.05).Conclusion For the elderly patients undergoing proximal femoral nail antirotation surgery, ultrasound-guided lumbar plexus and sciatic plexus nerve block combined with nasopharyngeal airway can reduce usage of propofol during operation, shorten the length of hospital stay, and benefit postoperative outcome in the patients when compared with laryngeal mask airway.