Abstract:【Objective】To explore the effect of ultrasound-guided nerve block and general anesthesia combined for elderly lower limb fracture surgery. 【Methods】A total of 268 elderly patients who underwent lower limb fracture surgery were randomly divided into an observation group (using ultrasound-guided nerve block combined with general anesthesia, 134 cases) and a control group (using general anesthesia, 134 cases). Comparisons were made between two groups in terms of anesthesia effectiveness, dosage of anesthetic drugs, awakening time, removal time of laryngeal mask, pain visual analogue scale (VAS), and adverse reactions; The average arterial pressure (MAP), heart rate (HR), prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (APTT) levels were compared between two groups at different time points.【Result】 The excellent anesthesia rate in the observation group was higher than that in the control group (P<0.05); The observation group used less anesthesia, had shorter awakening time and removal time of the laryngeal mask, and had lower postoperative VAS scores than the control group (P<0.05); There was no statistically significant difference (P>0.05) in the MAP and HR of the observation group at the insertion (T1), incision (T2), and removal (T3) of the laryngeal mask compared to before anesthesia (T0). The MAP and HR of the control group were significantly higher at T1, T2, and T3 than at T0, while the MAP and HR of the observation group were significantly lower at T1, T2, and T3 than those of the control group (P<0.05); The PT, TT, and APTT of the observation group were significantly higher than those of the control group at time points T2 and T3 (P<0.05); The total incidence of adverse reactions in the observation group was lower than that in the control group (P<0.05).【Conclusion】 Ultrasound guided nerve block combined with general anesthesia has a relatively small impact on hemodynamics in elderly patients undergoing lower limb fracture surgery, better anesthesia effect, stable signs during surgery, and high clinical application value.
张衍平, 李现虎, 李康. 超声引导下神经阻滞联合全麻用于老年下肢骨折术中的效果[J]. 医学临床研究, 2024, 41(4): 569-571.
ZHANG Yanping, LI Xianhu, LI Kang. The Effect of Ultrasound-guided Nerve Block Combined with General Anesthesia for Elderly Lower Limb Fracture Surgery. JOURNAL OF CLINICAL RESEARCH, 2024, 41(4): 569-571.
[1] GUO L S, WANG L N, XIAO J B, et al. Association between anesthesia technique and complications after hip surgery in the elderly population[J].World J Clin Cases,2022, 10(9):2721-2732. [2] 马漪洁, 鲍乐乐, 张玉,等. 老年人下肢骨折手术采用全身麻醉与腰硬联合麻醉临床效果对比研究[J].重庆医学, 2021, 50(S2):98-100. [3] 焦晓红, 杨丹锋, 宋国军. 全身麻醉与腰硬联合麻醉对老年患者下肢骨折手术后认知功能的影响[J].实用临床医药杂志, 2019, 23(11):79-82. [4] AO C B, WU P L, SHAO L, et al. Clinical effect of ultrasound-guided nerve block and dexmedetomidine anesthesia on lower extremity operative fracture reduction[J].World J Clin Cases, 2022, 10(13):4064-4071. [5] 袁亮婧, 常颖, 伊军. 腰椎旁神经阻滞联合浅全麻对股骨转子间骨折手术患者血流动力学及疼痛的影响[J].现代中西医结合杂志, 2019, 28(20):2257-2260. [6] 钟日胜, 李兴艳, 秦东全,等. 超声引导下神经阻滞复合喉罩全麻在老年髋关节置换术患者中的应用优势评价[J].临床和实验医学杂志, 2019, 18(9):1006-1009. [7] 程立红,罗善志.超声引导神经阻滞对老年下肢骨折患者麻醉效果的观察[J].抗癌研究,2021,5(3):11-14. [8] DIXIT V, FATHIMA S, WALSH S M, et al. Effectiveness of continuous versus single injection femoral nerve block for total knee arthroplasty: a double blinded, randomized trial[J].Knee,2018, 25(4):623-630. [9] 钱祖超, 张群. 评价超声引导下下肢神经阻滞在高龄危重患者股骨头置换手术的麻醉效果及价值[J].中国全科医学, 2021, 24(S2):59-61. [10] MCLEOD G A, MCKENDRICK M, TAYLOR A, et al. An initial evaluation of the effect of a novel regional block needle with tip-tracking technology on the novice performance ofcadaveric ultrasound-guided sciatic nerve block[J].Anaesthesia,2020, 75(1):80-88. [11] 朱建国, 张友传, 冯毅承,等. 超声引导下髂筋膜神经阻滞对老年股骨近端骨折患者血流动力学与应激反应的影响[J].中华全科医学, 2021, 19(8):1310-1313. [12] 庄凯峰, 吴财能, 马武华. 超声引导下腰骶丛神经阻滞联合全身麻醉对髋关节置换患者血流动力学和氧化应激水平的影响[J].中国医学前沿杂志(电子版), 2021, 13(5):56-60. [13] 王伟. 超声引导下股神经及坐骨神经阻滞用于老年下肢骨折患者的麻醉效果及对血凝状态的影响分析[J].中国伤残医学, 2021, 29(4):49-51.