郭益群 1苏长生 1林慧梅 1庄渊钊 1谢文钦 1许志阳2
作者信息
- 1. 泉州市第一医院,麻醉科,泉州 362000
- 2. 泉州市第一医院,骨科,福建泉州 362000
- 折叠
摘要
Abstract
Objective To observe the anesthesia effect and safety of anesthesia induction+maintenance with lumbar plexus and parasacral sciatic nerve block combined with remimazolam on elderly patients with proximal femoral fractures.Methods Patients with proximal femoral fractures were divided into control group and treatment group according to cohort method.The control group received 0.4％ropivacaine(25-30 mL)lumbar plexus and 0.4％ropivacaine(15-20 mL)parasacral sciatic nerve block+0.4-0.6 μg·kg-1 dexmedetomidine maintenance anesthesia,while the treatment group was combined with 0.2-0.4 mg·kg-1 remimazolam anesthesia induction+0.15-0.35 mg·kg-1·h-1 remimazolam maintenance anesthesia on the basis of the control group.The surgical anesthesia effect,nerve block status,perioperative hemodynamic indexes[heart rate(HR)and mean arterial pressure(MAP)],recovery quality(recovery time,Ramsay sedation score and restlessness at 2 hours after surgery),postoperative pain status and occurrence of postoperative delirium were compared between two groups of patients.Results Fourty-nine cases in control group and 53 cases in treatment group were finally included.The excellent and good rate of anesthesia effect in control group and treatment group were 79.59％and 94.35％(all P＜0.05).The perfection rates of T12,L3,L4 and L5 nerve blocks in treatment group were 79.25％,100.00％,100.00％and 98.11％,which were higher than 22.45％,91.84％,89.80％and 79.59％in control group(all P＜0.05).The onset time of sensory nerve block in treatment group with(5.37±1.22)min was shorter than(6.18±1.28)min in control group,and the maintenance time of motor nerve block with(201.37±33.97)min was shorter than(241.36±42.47)min in control group(all P＜0.05).The HR values at the beginning(T1),the end(T2)and 2 h after the end(T3)of surgery in treatment group with(71.64±3.13),(74.14±3.27)and(77.86±3.54)beat·min-1 were higher than(65.68±3.24),(67.68±3.21)and(71.25±3.54)beat·min-1 in control group(all P＜0.05).MAP values at T1,T2 and T3 in treatment group were(86.54±3.24),(89.24±3.54)and(92.35±4.21)mmHg,which were higher than(80.36±3.47),(83.22±3.51)and(86.22±4.22)mmHg in control group(all P＜0.05).The recovery time and incidence rate of restlessness in treatment group were lower than those in control group,and the Ramsay sedation score at 2 h after surgery was higher than that in control group(all P＜0.05).The VAS scores of the treatment group T3,12 h(T4)and 24 h(T5)after surgery were all lower than those of the control group(all P＜0.05).The incidence rate of delirium in control group was 12.24％,and there was no delirium in treatment group(P＜0.05).Conclusion The application of lumbar plexus and parasacral sciatic nerve block combined with remimazolam anesthesia induction+maintenance anesthesia in elderly patients with proximal femoral fractures has a better anesthesia effect than lumbar plexus and sacral sciatic nerve block alone and the former one has higher nerve block perfection rate and can maintain intraoperative blood flow stability and reduce the incidence rate of postoperative delirium.关键词
瑞马唑仑注射剂/坐骨神经/股骨上段骨折/阻滞完善度/术中血流/谵妄Key words
remimazolam injection/sciatic nerve/proximal femoral fractures/block perfection/intraoperative blood flow/delirium分类
医药卫生
