超声引导股神经-股外侧皮神经阻滞联合喉罩全麻在股骨干骨折手术的应用效果

目的 探讨超声引导下股神经-股外侧皮神经阻滞联合喉罩全麻用于股骨干骨折手术的临床效果。方法 选择2014年9月到2018年5月黄山市人民医院收治的股骨干骨折手术患者30例，采用股神经-股外侧皮神经阻滞联合喉罩全麻，超声定位后注入0.5%罗哌卡因15 mL阻滞股神经和0.375%罗哌卡因5 mL阻滞股外侧皮神经。观察患者神经阻滞前（T₀）、阻滞后5 min（T₁）、10 min（T₂）、15 min（T₃）、30 min（T₄）的血流动力学变化；观察感觉及运动阻滞的起效和持续时间；同时观察有无恶心、呕吐及术后尿潴留等不良反应。结果 30例患者T₀、T₁、T₂、T₃、T₄收缩压分别为（144.67±14.81）、（141.53±14.32）、（141.67±13.88）、（142.00±12.40）、（145.00±11.65）mmHg，不同时间点收缩压的差异无统计学意义（P>0.05）。T₀、T₁、T₂、T₃、T₄舒张压分别为（79.73±4.39）、（77.90±4.29）、（79.87±3.87）、（78.77±4.29）、（79.17±3.48）mmHg，不同时间点舒张压的差异无统计学意义（P>0.05）。T₀、T₁、T₂、T₃、T₄心率分别为（80.00±4.98）、（78.90±3.21）、（78.33±3.92）、（79.33±3.02）、（78.07±3.38）次/分，不同时间点心率的差异无统计学意义（P>0.05）。患者感觉阻滞的起效时间平均为（6.77±0.90）min，持续时间为（339.90±65.67）min；运动阻滞的起效时间平均为（12.23±2.28）min，持续时间为（213.00±39.08）min。30例患者均无恶心、呕吐及术后尿潴留发生。结论 超声引导下行股神经-股外侧皮神经阻滞联合喉罩全麻应用于股骨干骨折手术，血流动力学稳定，镇痛时间长，术后并发症极少，可推广应用。

Clinical application of ultrasound guided femoral nerve-lateral femoral nerve block combined with laryngeal mask general anesthesia in operation of femoral shaft fracture

Objective To investigate the clinical effect of ultrasound guided femoral nerve-lateral femoral cutaneous nerve block combined with laryngeal mask general anesthesia in the treatment of femoral shaft fractures. Methods Thirty cases of femoral shaft fracture treated by Huangshan People''s Hospital from September 2014 to May 2018 were selected,femoral and lateral femoral cutaneous nerve block combined with laryngeal mask general anesthesia were used, and 0.5% ropivacaine was injected with 15 mL and 0.375% ropivacaine with 5 mL to block lateral femoral cutaneous nerve.Then hemodynamic changes before nerve block(T₀),and 5 min(T₁), 10 min(T₂), 15 min(T₃), 30 min(T₄) after nerve block were observed. The effect and duration of sensory and motor block was assessed. At the same time,adverse reactions such as nausea, vomiting and postoperative urinary retention were also observed. Results T₀, T₁, T₂, T₃, T₄ systolic pressure was(144.67±14.81),(141.53±14.32),(141.67±13.88),(142.00±12.40),(145.00±11.65) mmHg, respectively, and there was no significant differenceat different time points (P>0.05). T₀, T₁, T₂, T₃, T₄ diastolic pressure was(79.73±4.39),(77.90±4.29),(79.87±3.87),(78.77±4.29),(79.17±3.48) mmHg,respectively, and the difference at different points was not statistically significant(P>0.05). The heart rates of T₀, T₁, T₂, T₃, and T₄ were(80.00±4.98),(78.90±3.21),(78.33±3.92),(79.33±3.02),(78.07±3.38) times/minute, and the difference between different points was not statistically significant(P>0.05). The average onset time of the patient sensory block was (6.77±0.90) min and the duration was(339.90±65.67) min. The average onset time of motion block was(12.23±2.28) min and the durationwas(213.00±39.08) min. No nausea, vomiting or postoperative urinary retention occurred in 30 patients. Conclusion Ultrasonically guided femoral nerve-lateral femoral cutaneous nerve block combined with laryngeal mask general anesthesia can be widely applied to the operation of femoral shaft fracture, with stable hemodynamics, long analgesia time and few complications.