Objective To investigate the anesthetic effect and safety of lumbar plexus-sciatic nerve block in internal fixation of femoral neck fractures among elderly.Methods Total of 128 cases of femoral neck fracture elder patients from May 2014 to May 2016 in Zigong First People′s Hospital who treated with internal fixation were divided into observation group(n=64)and control group(n=64)according to random digits.The control group was given conventional trachea can-nula and general anesthesia,and then intravenous injection etomidate +0.02 mg/kg midazolam+0.3 μg/kg sufentanil +0.6 mg/kg rokubromide,and the continuous intravenous infusion of propofol was maintained after anesthesia.The observa-tion group were underwented lumbar plexus-sciatic nerve block.Lumbar plexus blockwas given 0.5% lidocaine+0.25%ropivacaine+0.5 μg/kg dextromethorphanl, sciatic nerve block administered with 1% lidocaine +0.5% ropivacaine +0.5 μg/kg dextromethorphan.The levels of mean arterial pressure(MAP),heart rate,arterial oxygen saturation(SaO2), end-tidal carbon dioxide partial pressure(PETCO2)at 5 min before anesthetic block(T0),10 min after anesthesia(T1), the start of surgery(T2), one hour after anesthesia completion(T3), the end of surgery(T4)of the two groups were recorded.The lumbar plexus and sciatic nerve sensory and motor block onset,duration and adverse event of two groups were recorded.Results The MAP,HR and PETCO2of the two groups increased gradually with the anesthesia and surgery,and then slowly decreased,the MAP and PETCO2of observation group returned to the levels before anesthesia,and the control group was higher than observation group.The heart rate fluctuation of observation group was smaller than that of control group,and the range was better than the control group.The SaO2of the two groups were lower at the first and then step-up, the fluctuation of observation group was smaller.There were significant differences betweenthe groups,time points and time points· groups on MAP,HR,SaO2and PETCO2(P <0.01).There was no significant difference on the movement and sensory onset time of lumbar plexus and sciatic nerve between the two groups(P>0.05).The lumbar plexus and sciatic nerve motor and sensory block ofobservation group were longer than the control group[(512 ±72)s vs(313 ±75)s, (526 ±90)s vs(305 ±82)s,(678 ±99)s vs(412 ±85)s,(648 ±92)s vs(405 ±69)s](P<0.01).The incidence of complications such as cognitive dysfunction, nausea, vomiting,restlessness and respiratory depression of observation group was lower than control group[4.68%(3/64)vs 45.31%(29/64)](P<0.05).Conclusion The lumbar plexus-sciatic nerve block will effectively stabilize the hemodynamics of elderly femoral neck fracture patients,prolong the duration oflumbar plexusand sciatic nerve movement and sensory block,and the complications are less.%目的 探讨腰丛-坐骨神经阻滞在老年股骨颈骨折内固定术中的麻醉效果及安全性.方法 选择2014年5月至2016年5月自贡市第一人民医院收治的128例老年股骨颈骨折内固定术患者为研究对象,根据随机数字法将患者分为观察组(n=64)和对照组(n=64),对照组行常规气管插管全身麻醉操作,全身麻醉诱导后静脉注射依托咪酯+0.02 mg/kg咪达唑仑+0.3 μg/kg舒芬太尼+0.6 mg/kg 罗库溴铵,维持麻醉后持续静脉滴注丙泊酚;观察组行腰丛-坐骨神经阻滞.腰丛神经阻滞给予0.5%利多卡因+0.25%罗哌卡因+0.5 μg/kg右美托咪定,坐骨神经阻滞给予1%利多卡因+0.5%罗哌卡因+0.5 μg/kg右美托咪定,记录两组患者麻醉前5 min(T0)、麻醉后10 min(T1)、手术开始时(T2)、麻醉后1 h(T3)、术毕(T4)时的平均动脉压(MAP)、心率、动脉血氧饱和度(SaO2)、呼吸末二氧化碳分压(PETCO2);记录两组患者腰丛及坐骨神经感觉及运动阻滞起效时间、持续时间及两组患者并发症发生情况.结果 两组患者MAP、心率以及PETCO2随麻醉和手术的进行逐渐升高,而后又缓慢降低,其中观察组的MAP和PETCO2均恢复到麻醉前水平,而对照组的水平较观察组高,观察组的心率波动较对照组小,且范围较对照组更为理想;两组患者的SaO2先降低后升高,但观察组的波动较对照组小.两组患者的MAP、心率、SaO2以及PETCO2组间、时点间以及组间· 时点间比较,差异均有统计学意义(P<0.01).两组患者腰丛及坐骨神经运动及感觉神经阻滞起效时间比较差异无统计学意义(P>0.05);观察组患者腰丛神经及坐骨神经运动及感觉神经阻滞持续时间长于对照组[(512 ±72)s比(313 ±75)s、(526 ±90)s比(305 ±82)s,(678 ±99)s比(412 ±85)s, (648 ±92)s比(405 ±69)s](P<0.01);观察组认知功能障碍、恶心呕吐、躁动、呼吸抑制等并发症的发生率显著低于对照组[4.68%(3/64)比45.31%(29/64)](P<0.05).结论 腰丛-坐骨神经阻滞能有效稳定老年股骨颈骨折内固定术患者的血流动力学,延长患者腰丛神经及坐骨神经感觉和运动阻滞持续时间,且术后麻醉并发症少.
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