2020 年第 5 期 第 15 卷

后路腰丛神经阻滞在绝经后骨质疏松性股骨粗隆下粉碎性骨折患者手术中的麻醉效果分析

Anesthetic effect of posterior lumbar plexus block on postmenopausal osteoporotic femoral comminuted fracture

作者：谢妍;费国雄

英文作者：Xie Yan Fei Guoxiong

单位：上海市徐汇区中心医院麻醉科200031

英文单位：Department of Anesthesiology Xuhui District Central Hospital Shanghai 200031 China

关键词：股骨粗隆下粉碎性骨折；绝经后；骨质疏松；后路腰丛神经阻滞；麻醉效果

英文关键词：Comminutedfractureoffemoraltrochanter；Postmenopausal；Osteoporosis；Posteriorlumbarplexusblock；Anestheticeffect

• 摘要：

• 目的 探究后路腰丛神经阻滞在绝经后骨质疏松性股骨粗隆下粉碎性骨折患者手术中的麻醉效果。方法 选取2018年1月1日至2019年1月1日上海市徐汇区中心医院收治的绝经后骨质疏松性股骨粗隆下粉碎性骨折患者76例作为研究对象，采用随机数字表法分为A组（后路腰丛神经阻滞麻醉）和B组（硬膜外麻醉），各38例。比较2组患者麻醉前（T0）、麻醉后10 min（T1）、术毕（T2）、术毕后2 h（T3）的血流动力学指标，麻醉后脑电双频指数（BIS），阻滞起效时间，麻醉诱导时间和不良反应发生情况。结果 2组患者T1、T2、T3时点平均动脉压（MAP）、中心静脉血氧饱和度（ScrO2）、胸腔内血容量指数（ITBVI）和全心舒张末期容积指数（GEDVI）均明显高于T0时点，而心率和氧合指数均明显低于T0时点（均P＜0.05）；但A组患者在T1～T3时点，除心率外，MAP、氧合指数、ScrO2、ITBVI和GEDVI均明显稳定于B组，差异均有统计学意义（均P＜0.05）。A组患者麻醉后5、15、30 min时的脑电双频指数均优于B组［（21±7）比（33±7）、（27±5）比（43±11）、（44±5）比（56±10）］，且阻滞起效时间、麻醉诱导时间均明显短于B组［（2.8±0.8）min比（8.3±2.9）min、（13.1±2.2）min比（24.9±3.5）min］（均P＜0.05）。2组患者术后不良反应总发生率比较，差异无统计学意义（P=0.175）。结论后路腰丛神经阻滞应用于绝经后骨质疏松性股骨粗隆下粉碎性骨折患者具有较佳的麻醉效果和镇静效果，有助于稳定血流动力学指标，且安全性良好。

• Objective To investigate the anesthetic effect of posterior lumbar plexus block on postmenopausal osteoporotic femoral comminuted fractures. Methods Seventy-six patients with postmenopausal osteoporotic subtrochanteric comminuted fracture of femur admitted to Shanghai Xuhui District Central Hospital from 1st January, 2018 to 1st January, 2019 were enrolled. They were randomly divided into group A (posterior lumbar plexus block anesthesia) and group B (epidural anesthesia), with 38 cases in each group. The hemodynamic indexes before anesthesia (T0), 10 min after anesthesia (T1), end of surgery (T2) and 2 h after operation (T3), bispectral index (BIS), onset time of anesthesia, induction time of anesthesia and adverse reactions were compared. Results At T1, T2, T3, mean arterial pressure（MAP）, central venous oxygen saturation（ScrO2）, intrathoracic blood volume index (ITBVI) and global end-diastolic volume index (GEDVI) were significantly higher than those at T0; heart rate and oxygenation index(PaO2/FiO2) were significantly lower than those at T0 time point (all P＜0.05); but at T1-T3 time points, MAP, PaO2/FiO2, ScrO2, ITBVI and GEDVI were stable in group A. The BIS in group A at 5, 15 and 30 min after anesthesia were better than those in group B［（21±7） vs （33±7）,（27±5） vs （43±11）,（44±5） vs （56±10）］; the onset time of block and induction time of anesthesia were significantly shorter than those in group B［（2.8±0.8）min vs （8.3±2.9）min,（13.1±2.2）min vs （24.9±3.5）min］ (P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P=0.175). Conclusions Anesthesia with posterior lumbar plexus block for patients with postmenopausal osteoporotic femoral trochanteric fracture is safe and effective.