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周围神经阻塞与骨骨折患者的选择性脊髓麻醉:一个患者,外科医生和评估人员盲目的随机对照研究

Antonio Coviello¹, Dario Cirillo², Alessio Bernasconi³

¹Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.

Journal of anesthesia, analgesia and critical care

|December 4, 2025

概括

与选择性脊髓麻醉 (SSA) 相比,外周神经阻塞 (PNB) 在手术期间为患有近端大腿骨骨折 (PFF) 的老年患者提供了优越的血液动力稳定性. 此外,PNB还可以减少术后妄想,改善疼痛管理,提供更安全的麻醉选择.

科学领域:

麻醉学麻醉学
老年医学老年医学
整形外科手术整形外科手术

背景情况:

靠近大腿骨骨折 (PFF) 在老年人中很普遍,往往导致严重的残疾.
对于PFF的麻醉学管理通常涉及脊髓麻醉 (SA) 或外围神经阻塞 (PNBs).
在接受PFF手术固定的老年患者中,比较SA和PNB的疗效和安全性至关重要.

研究的目的:

为了比较选择性脊髓麻醉 (SSA) 与外围神经阻塞 (PNB) 的疗效和安全性,在接受近端股骨骨折 (PFF) 手术固定的老年患者中.
作为首要结果,评估手术内血动力学不稳定性.
评估手术内和手术后的不良事件以及止痛药的有效性.

主要方法:

一个单心的,患者,外科医生和评估者盲目的随机研究.
患有PFF的患者被随机分配到接受选择性脊髓麻醉 (SSA) 或联合外周神经阻塞 (PNB).
评估包括手术内和手术后的不良事件和镇痛疗效.

主要成果:

与SSA组相比,PNB组表现出明显较低的手术内血动力学不稳定性 (16.7%vs43.4%) 和心 (10%vs33.3%).
虽然PNB组的动员速度较慢,但这些患者住院时间较短.
在止痛药救援剂量或重大术后并发症 (PONV,DVT,MI,神经损伤) 中没有发现显著差异.

结论:

周围神经阻塞 (PNBs) 为老年人近端股骨骨折手术提供了选择性脊髓麻醉 (SSA) 的可行替代方案.
PNBs提供了增强的手术内血动力学稳定性和手术后痴呆的发病率降低.
与SSA相比,PNB还有助于改善术后止痛.

关键词:

股骨骨折股骨骨折股骨骨折局部区域麻醉局部区域麻醉整形外科创伤外科手术周围神经的阻断.随机对照研究是随机对照研究.脊髓麻醉脊髓麻醉

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