2019 年第 7 期 第 14 卷

丙泊酚静脉麻醉复合局部浸润麻醉对老年髋部骨折患者围术期应激反应的影响

Effect of propofol intravenous anesthesia combined with local infiltration anesthesia on perioperative stress response in elderly patients with hip fracture

作者：赵华宇刘彦辉刘平水康书峰

英文作者：

单位：050051石家庄，河北医科大学第三医院友谊院区麻醉科（赵华宇、刘彦辉、刘平水）；050035石家庄，河北医科大学第三医院湘江院区麻醉科（康书峰）

英文单位：

关键词：髋部骨折；丙泊酚；静脉麻醉；局部浸润麻醉；应激反应

英文关键词：

• 摘要：

• 【摘要】目的    观察丙泊酚静脉麻醉复合局部浸润麻醉对老年髋部骨折患者围术期应激反应的影响。方法    选取2014年1月至2017年12月河北医科大学第三医院收治的老年髋部骨折手术患者90例为研究对象。完全随机分为对照组和观察组，各45例。2组患者术前常规给予肌内注射阿托品0.1 mg/kg和咪达唑仑0.05 mg/kg。对照组给予丙泊酚静脉麻醉；观察组在对照组基础上给予局部浸润麻醉。比较2组患者阻滞相关指标、术后镇痛效果评分及应激反应相关指标的差异。结果    观察组痛觉阻滞起效时间短于对照组，痛觉阻滞持续时间长于对照组，差异均有统计学意义［（40±6）s比（62±5）s、（513±19）min比（296±12）min］（t=1.869，P<0.001； t=2.451，P=0.032）。观察组术后4、8、12及16 h的静息数字评分法评分均明显低于对照组，差异均有统计学意义（均P<0.05）。麻醉后2 h，2组患者丙二醛、白细胞介素1β及白细胞介素2水平均高于麻醉前，观察组低于对照组；2组超氧化物歧化酶水平均明显低于麻醉前，观察组高于对照组，差异均有统计学意义（均P<0.05）。结论    丙泊酚静脉麻醉复合局部浸润麻醉对老年髋部骨折患者麻醉效果好，且不引起剧烈的应激反应。

• 【Abstract】Objective    To observe the effect of propofol intravenous anesthesia combined with local infiltration anesthesia on perioperative stress response in elderly patients with hip fracture. Methods    From January 2014 to December 2017, 90 elderly patients undergoing hip fracture surgery in the Third Hospital of Hebei Medical University were randomly divided into control group and observation group, with 45 cases in each group. All patients were given intramuscular injection of atropine 0.1 mg/kg and midazolam 0.05 mg/kg before operation. The control group had propofol intravenous anesthesia and the observation group had propofol intravenous anesthesia plus local infiltration anesthesia. Nerve blocking indicators, postoperative analgesic effect and stress response indexes were analyzed. Results    Onset time of pain blocking in observation group was shorter and duration of pain blocking was longer than those in control group, the difference were statistically significant［（40±6）s vs （62±5）s, （513±19）min vs （296±12）min］（t=1.869, P<0.001; t=2.451, P=0.032）. Scores of Numeric Rating Scales at 4, 8, 12,16 hours after operation in observation group were significantly lower than those in control group(all P<0.05). At 2 hours after anesthesia, levels of malondialdehyde, interleukin-1β and interleukin-2 were higher than those before anesthesia in both groups; the levels in observation group were lower than those in control group; the level of superoxide dismutase were lower than those before anesthesia and it was higher in observation group than that in control group(all P<0.05). Conclusion    Propofol intravenous anesthesia combined with local infiltration anesthesia has a good anesthetic effect on elderly patients undergoing hip fracture surgery and does not cause severe stress response.