不同时间股神经-坐骨神经阻滞对胫腓骨骨折患者术后疼痛与谵妄的影响比较OA
Comparison of the Effects of Femoral-sciatic Nerve Block at Different Times on Postoperative Pain and Delirium in Patients with Tibiofibular Fractures
目的:比较不同时间股神经-坐骨神经阻滞对胫腓骨骨折患者术后疼痛与谵妄的影响.方法:采取回顾性分析法,将 2022 年 7 月—2023 年 6 月福州市第二医院麻醉科收治的 100 例胫腓骨骨折患者根据股神经-坐骨神经阻滞时间不同分成A组与B组,A组 50 例于气管插管后手术切皮前(术前)行股神经-坐骨神经阻滞,B组 50 例于手术缝合结束即刻(术后)行股神经-坐骨神经阻滞,两组其余麻醉方法相同.观察两组麻醉效果、术后疼痛程度、认知功能、术后谵妄及不良反应发生率.结果:A组神经阻滞镇痛持续时间长于B组,差异有统计学意义(P＜0.05),A组术后苏醒时间早于B组,丙泊酚用量、瑞芬太尼用量均少于B组,差异均有统计学意义(P＜0.05);A组术后 2、6、12、24 h视觉模拟评分法(VAS)评分均低于B组,差异均有统计学意义(P＜0.05);两组术后 1、3 d的简易智力状态检查量表(MMSE)评分均低于术前,A组术后 1、3 d的MMSE评分均高于B组,差异均有统计学意义(P＜0.05);A组术后谵妄发生率低于B组,差异有统计学意义(P＜0.05);A组不良反应发生率低于B组,差异有统计学意义(P＜0.05).结论:术前股神经-坐骨神经阻滞在胫腓骨骨折患者手术中的应用效果较好,与术后股神经-坐骨神经阻滞相比,能够延长神经阻滞镇痛持续时间,缩短术后苏醒时间,减少麻醉维持用药量,减轻术后疼痛及认知功能损伤,降低术后谵妄及不良反应发生率.
Objective:To compare the effects of femoral-sciatic nerve block at different times on postoperative pain and delirium in patients with tibiofibular fractures.Method:A retrospective analysis was used to divide 100 patients with tibiofibular fractures admitted to Department of Anesthesiology,Fuzhou Second Hospital from July 2022 to June 2023 into group A and group B based on different times of femoral nerve sciatic nerve block.Group A had 50 patients who received femoral-sciatic nerve block after tracheal intubation and before surgical skin incision(before surgery),while group B had 50 patients who received femoral nerve sciatic nerve block immediately after surgical suture(after surgery),the other anesthesia methods in both groups were the same.The anesthesia effect,postoperative pain level,cognitive function,postoperative delirium,and incidence of adverse reactions in both groups were observed.Result:The duration of nerve block analgesia in group A was longer than that in group B,with significant difference(P＜0.05),and the postoperative recovery time in group A was earlier than that in group B,Propofol dosage and Remifentanil dosage in group A were lower than those in group B,with significant differences(P＜0.05).The visual analogue scale(VAS)scores at 2,6,12,24 h after surgery in group A were lower than those in group B,with significant differences(P＜0.05).The mini-mental state examination(MMSE)scores of two groups were lower at 1 and 3 d after surgery than before surgery,the MMSE scores of group A were higher than those of group B at 1 and 3 d after surgery,with significant differences(P＜0.05).The incidence of postoperative delirium in group A was lower than that in group B,with significant difference(P＜0.05).The incidence of adverse reactions in group A was lower than that in group B,with significant difference(P＜0.05).Conclusion:The application effect of preoperative femoral-sciatic nerve block in the surgery of patients with tibiofibular fractures is good,compared with postoperative femoral-sciatic nerve block,it can prolong the duration of nerve block analgesia,shorten postoperative recovery time,reduce the amount of anesthesia maintenance medication,alleviate postoperative pain and cognitive function damage,reduce the incidence of postoperative delirium and adverse reactions.
刘景铠;谢东进;陈晓梅
福州市第二医院麻醉科 福建 福州 350007
股神经-坐骨神经阻滞胫腓骨骨折术后疼痛谵妄
Femoral-sciatic nerve blockTibiofibular fracturesPostoperative painDelirium
《中国医学创新》 2024 (001)
5-9 / 5
福州市临床重点专科建设项目(20220202)
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