冯宝莹+张习良+游玉媛+杜杰强

【摘要】 目的 探究超聲-刺激仪双重引导下多点式前路腰丛阻滞在老年股骨近端骨折手术中的应用效果。方法 150例>70岁、美国麻醉医师协会（ASA）分级1～3级的老年股骨近端骨折手术患者， 随机分为超声-刺激仪双重引导下多点式前路腰丛阻滞组（A组）、后路腰丛组（B组）和腰麻组（C组）， 每组50例。比较麻醉过程中麻醉效果、术后麻醉相关并发症， 近期及远期死亡率。结果 术前1 d（T0）三组血流动力学指标比较差异无统计学意义（P>0.05）；切皮（T1）～缝合（T4）时三组比较差异具有统计学意义（P<0.05）。T1～T4时A组与B组辅助吸入七氟烷浓度比较差异无统计学意义（P>0.05）。A组2例呼吸不好置入喉罩， 2例麻醉效果不全置入喉罩， 2例需要应用血管活性药。B组2例呼吸不好置入喉罩， 7例麻醉效果不全置入喉罩， 5例需要应用血管活性药。B组发生麻醉效果不全需插入喉罩例数多于A组， 但差异无统计学意义（P>0.05）。C组有13例需要应用血管活性药， 与A组需要应用血管活性药例数比较差异有统计学意义（P<0.05）。三组近期、远期死亡率及术后并发症发生率比较差异无统计学意义（P>0.05）。结论 超声-刺激仪双重引导下多点式前路腰丛阻滞具有良好麻醉效果， 对老年股骨近端骨折患者血流动力学指标影响较小， 并发症少， 具有较高的应用价值。

【关键词】 超声-刺激仪双重引导；多点式前路腰丛阻滞；老年股骨近端骨折

DOI：10.14163/j.cnki.11-5547/r.2018.05.004

【Abstract】 Objective To investigate the application effect of multi-point anterior lumbar plexus block under dual guidance of ultrasound-stimulator in the treatment of elderly proximal femoral fracture. Methods A total of 150 elderly patients over 70 years old and American Society of Anesthesiologists （ASA） graded 1～3 with proximal femoral fracture were randomly divided into multi-point anterior lumbar plexus block under dual guidance of ultrasound-stimulator group （group A）， posterior lumbar plexus group （group B） and lumbar anesthesia group （group C）， with 50 cases in each group. Comparison were made on anesthetic effect， postoperative anaesthesia related complications， short-term and long-term mortality. Results There was no statistically significant difference in hemodynamic indicators in 1 d before operation （T0） （P>0.05）， and there was statistically significant difference at cutting （T1） ～ suturing （T4） between the three groups （P<0.05）. Group A and group B had no statistically significant difference in assisted inhalation of sevoflurane concentrations at T1 ～ T4 （P>0.05）. Group A had 2 cases with laryngeal mask due to poor breathing， 2 cases due to incomplete anesthesia and 2 cases due to vasoactive drug requirement， which were 2， 7 and 5 cases in group B. Group B had more cases with laryngeal mask due to incomplete anesthesia than group A， but the difference was not statistically significant （P>0.05）. Group C had 13 cases required vasoactive drug， which had statistically significant difference comparing with group A （P<0.05）. Three groups had no statistically significant difference in short-term and long-term mortality and incidence of postoperative complications （P>0.05）. Conclusion Multi-point anterior lumbar plexus block under dual guidance of ultrasound-stimulator shows good anesthesia effect with little influence on hemodynamic indexes of elderly patient with proximal femoral fracture and fewer complications， and it has high application value.endprint

【Key words】 Dual guidance of ultrasound-stimulator； Multi-point anterior lumbar plexus block； Elderly proximal femoral fracture

目前， 国内外对老年股骨近端骨折麻醉方式趋向使用外周神经阻滞技术。大多采用后路腰丛加坐骨神经阻滞技术， 再放置喉罩做吸入全身麻醉或静脉输注异丙酚和用阿片类药物[1]。老年股骨近端骨折手术患者手术耐受性较差， 探究优势麻醉方式具有重要意义。本研究选取……