标题：超声引导髂筋膜阻滞联合单侧腰椎麻醉在老年股骨骨折手术中的应用

      作者：谢娟华，赵姣姣，刘枧辉，周艳红，周海红，旷昕    深圳市龙华区人民医院麻醉科，广东 深圳 518110

      卷次： 2021年32卷15期

      【摘要】 目的 研究超声引导髂筋膜阻滞联合单侧腰椎麻醉在老年股骨骨折手术中的应用效果。方法 选择2019年6月至2020年6月深圳市龙华区人民医院收治的80例老年股骨骨折患者进行研究，按随机数表法分为对照组和观察组，每组40例。对照组应用腰硬联合麻醉，观察组采用超声引导髂筋膜阻滞联合单侧腰椎麻醉。比较两组患者麻醉前舒芬太尼用量、手术麻醉效果、术后12 h、24 h、48 h、72 h简易精神状态评价量表(MMSE)评分、视觉模拟评分量表(VAS)评分及术后并发症发生情况。结果 观察组患者麻醉前舒芬太尼用量为(414.3±87.7) μg，明显少于对照组的(736.9±121.4) μg，差异有统计学意义(P<0.05)；观察组患者的麻醉效果明显优于对照组，差异有统计学意义(P<0.05)；观察组患者术后12 h、24 h及48 h的MMSE评分分别为(17.3±3.2)分、(23.4±3.6)分、(26.7±3.9)分，明显高于对照组的(14.1±2.8)分、(19.5±3.3)分、(24.6±3.8)分，差异均有统计学意义(P<0.05)；观察组患者术后 12 h、24 h及 48 h的VAS评分分别为(2.36±0.82)分、(3.64±0.86)分、(1.73±0.66)分，明显低于对照组的(3.73±0.91)分、(4.21±0.95)分、(2.96±0.72)分，差异均有统计学意义(P<0.05)，但两组患者术后 72 h的MMSE评分及VAS评分比较差异均无统计学意义(P>0.05)；观察组患者术后并发症发生率为 5.0%，明显低于对照组的 22.5%，差异有统计学意义(P<0.05)。结论 超声引导髂筋膜阻滞联合单侧腰椎麻醉在老年股骨骨折手术中的应用效果良好，可有效加强麻醉效果，减少术中舒芬太尼的用量，降低患者术后疼痛感，减轻对患者认知功能的影响，具有临床应用价值。
      【关键词】 股骨骨折；老年；超声；髂筋膜阻滞；腰硬麻醉；认知功能；并发症
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2021）15—1998—04

Application of ultrasound-guided iliac fascia block combined with unilateral lumbar anesthesia in elderlypatients with femoral fracture.
XIE Juan-hua, ZHAO Jiao-jiao, LIU Jian-hui, ZHOU Yan-hong, ZHOU Hai-hong,KUANG Xin. Shenzhen Longhua District People's Hospital, Shenzhen 518110, Guangdong, CHINA
【Abstract】 Objective To study the application effect of ultrasound-guided iliac fascia block combined withunilateral lumbar anesthesia in elderly patients with femoral fracture surgery. Methods Eighty elderly patients withfemoral fracture were selected from June 2019 to June 2020 in Shenzhen Longhua District People's Hospital. Accordingto the random number table method, the patients were divided into a control group and an observation group, with 40 pa-tients in each group. The control group was given combined spinal-epidural anesthesia, and the observation group wasgiven ultrasound-guided iliac fascia block combined with unilateral lumbar anesthesia. The dosage of sufentanil beforeanesthesia, anesthesia effect, MMSE score and VAS score at 12 h, 24 h, 48 h and 72 h after operation, and the incidenceof postoperative complications were compared between the two groups. Results The dosage of sufentanil before anes-thesia in the observation group was (414.3±87.7) μg, which was significantly lower than (736.9±121.4) μg in the con-trol group (P<0.05); the anesthetic effect of the observation group was significantly better than that of the controlgroup (P<0.05); the MMSE scores of the study group at 12 h, 24 h and 48 h after operation were (17.3±3.2) points,(23.4±3.6) points, and (26.7±3.9) points, which were significantly higher than (14.1±2.8) points, (19.5±3.3) points,(24.6±3.8) points of the control group (P<0.05); the VAS scores of the observation group at 12 h, 24 h and 48 h after op-eration were (2.36±0.82) points, (3.64±0.86) points, and (1.73±0.66) points, respectively, which were significantly lowerthan (3.73±0.91) points, (4.21±0.95) points, (2.96±0.72) points of the control group (P<0.05). There was no significantdifference in MMSE score and VAS score between the two groups at 72 h after operation (P>0.05). The incidence ofpostoperative complications in the study group was 5.0%, which was significantly lower than 22.5% of the control group(P<0.05). Conclusion The application effect of ultrasound-guided iliac fascia block combined with unilateral lumbaranesthesia in elderly patients with femoral fracture surgery is good, which can effectively strengthen the anesthesia ef-fect, reduce the amount of sufentanil in the operation, reduce the postoperative pain of patients, and reduce the impact onthe cognitive function of patients.
      【Key words】 Femoral fracture; Elderly; Ultrasound; Iliac fascia block; Spinal-epidural anesthesia; Cognitivefunction; Complications