腰硬联合麻醉与股神经-股外侧皮神经阻滞对老年下肢骨折患者术后镇痛及凝血功能的影响

Effects of combined spinal-epidural anesthesia versus femoral nerve-lateral femoral cutaneous nerve block on postoperative analgesia and coagulation function in elderly patients with lower limb fractures

摘要:

目的 探讨腰硬联合麻醉与股神经-股外侧皮神经阻滞对老年下肢骨折患者术后镇痛效果及凝血功能的影响。方法 选取2022年3月—2025年3月武警陕西省总队医院收治的96例老年下肢骨折患者，根据治疗方式不同分为对照组与联合组，各48例。对照组实施腰硬联合麻醉，联合组实施股神经-股外侧皮神经阻滞麻醉。比较两组患者的镇痛效果、凝血功能、血流动力学、麻醉效果指标及不良反应发生情况。结果 两组不同时间点视觉模拟评分法（VAS）比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②联合组与对照组VAS评分比较，差异有统计学意义（P <0.05）；③联合组与对照组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。对照组手术前后凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原的差值均大于联合组（P <0.05）。两组不同时间点平均动脉压（MAP）及心率（HR）比较，结果 ①不同时间点MAP和HR比较，差异均有统计学意义（P <0.05）；②联合组与对照组MAP和HR比较，差异均有统计学意义（P <0.05）；③联合组与对照组MAP和HR变化趋势比较，差异均有统计学意义（P <0.05）。联合组感觉阻滞起效时间、运动阻滞起效时间、感觉阻滞持续时间及运动阻滞持续时间均长于对照组（P <0.05）。联合组与对照组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 股神经-股外侧皮神经阻滞在获得良好镇痛效果的同时，术后凝血相关指标变化较小，安全性良好，具有一定的临床应用价值。

Abstract:

Objective To compare the effects of combined spinal-epidural anesthesia and combined femoral and lateral femoral cutaneous nerve block on postoperative analgesia and coagulation function among elderly patients with lower limb fractures.Methods A total of 96 elderly patients with lower limb fractures treated at Shaanxi Provincial Corps Hospital, Chinese People's Armed Police Force between March 2022 and March 2025 were enrolled and divided into a control group and a combined group according to different treatment modalities (48 patients in each group). Combined spinal-epidural anesthesia was administered in the control group, whereas femoral nerve block combined with lateral femoral cutaneous nerve block was administered in the combined group. Postoperative analgesic efficacy, coagulation indices, hemodynamic parameters, anesthetic features, and adverse event rates were compared between the two groups.Results There were statistically significant differences in visual analogue scale (VAS) scores at different time points (P < 0.05). The group effect showed significant differences between the combined group and the control group (P < 0.05), and a significant interaction between time and group was observed (P < 0.05). The pre- to postoperative changes in prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) were greater in the control group than in the combined group (P < 0.05). For mean arterial pressure (MAP) and heart rate (HR), significant differences were observed at different time points (P < 0.05). The group effects were statistically significant (P < 0.05), and significant interactions between time and group were also found (P < 0.05). The onset time of sensory block, onset time of motor block, duration of sensory block, and duration of motor block were all longer in the combined group than in the control group (P < 0.05). No significant difference was observed in the total incidence of adverse reactions between the two groups (P > 0.05).Conclusion Combined femoral and lateral femoral cutaneous nerve block provides effective postoperative analgesia, with less impact on postoperative coagulation-related indicators and good safety profile, and has clinical utility.