菲律宾综合医院脆性髋部骨折老年患者的外周神经阻滞疗效:为期6个月的前瞻性研究

Q4 Medicine
Acta Medica Philippina Pub Date : 2024-10-15 eCollection Date: 2024-01-01 DOI:10.47895/amp.vi0.9460
Karl Matthew C Sy Su, Ivan Gil P Balmadrid
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引用次数: 0

摘要

背景和目的:老年人髋部骨折仍然是一个严重的公共卫生问题。髋部骨折会导致极度疼痛的损伤,而老年人出现并发症的风险较高,因此对这一人群的疼痛管理具有挑战性。本研究旨在描述对即将接受择期或急诊髋部手术的老年脆性髋部骨折患者进行周围神经阻滞的效果:菲律宾总医院于 2022 年 5 月至 2022 年 11 月开展了一项单中心前瞻性队列研究。纳入的患者年龄在60岁及以上,患有脆性髋部骨折,需接受择期或急诊髋部手术,且美国麻醉医师协会(ASA)身体状况评分为1-3分。使用标准数据收集表收集患者的基线资料、术中特征和术后结果。数据收集者对所实施的阻滞类型进行了盲法处理:研究共纳入了 29 名接受髋关节手术的患者。大多数患者(65.5%)进行了蛛网膜下腔阻滞+外周神经阻滞(SAB+PNB),24.1%进行了全身麻醉+外周神经阻滞(GA+PNB),10.3%未进行外周神经阻滞(PNB)。阻滞后 30 分钟的数字评定量表(NRS)中位数与进行 PNB 阻滞的患者相似(P=0.977)(GA+PNB = 0,SAB+PNB = 0)。术后第 1 天(POD1)休息时的 NRS 中位数在无 PNB 组(3)明显高于 GA+PNB 组(0)和 SAB+PNB 组(0)(p=0.023)。相比之下,三组(GA+PNB = 0,SAB+PNB = 0,No PNB = 0)在 POD2 期间静息时的 NRS 中位数相似(p=0.713)。与 GA+PNB 组(0)和 SAB+PNB 组(1)相比,无 PNB 组(6)在 POD1 期间运动时的 NRS 中位数明显最高(p=0.008)。此外,在 POD2 期间,无 PNB 组(4 例)运动时的 NRS 中位数明显高于 GA+PNB 组(0 例)和 SAB+PNB 组(1 例)(P=0.009)。三组中,无 PNB 组术后阿片类药物的中位吗啡毫克当量(MME)明显更高(p=0.047)。三组的中位满意度评分(p=0.210)、POD2 的中位谵妄评分(p=0.993)和中位住院时间(p=0.173)均相似:结论:周围神经阻滞对接受脆性髋部骨折手术的老年患者有效。结论:外周神经阻滞对接受脆性髋部骨折手术的老年患者有效,可降低疼痛评分,与全身麻醉或蛛网膜下腔阻滞的效果相同。接受和未接受周围神经阻滞的患者在死亡率、谵妄发生率和住院时间上没有差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes of Peripheral Nerve Blocks in Elderly Patients with Fragility Hip Fractures in the Philippine General Hospital: A 6-month Prospective Study.

Background and objective: Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery.

Methods: A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1-3. Patients' baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed.

Results: A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups.

Conclusion: Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.

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来源期刊
Acta Medica Philippina
Acta Medica Philippina Medicine-Medicine (all)
CiteScore
0.40
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