2026 年第 5 期 第 21 卷

改良髂筋膜阻滞联合全身麻醉对中高海拔地区小儿股骨骨折术中血流动力学及苏醒质量的影响

Effects of modified fascia iliaca compartment block combined with general anesthesia on intraoperative hemodynamics and recovery quality in children with femoral fracture at medium and high altitudes

作者：刘颖1张弢2孙晓红1杨晓梅3

英文作者：Liu Ying1 Zhang Tao2 Sun Xiaohong1 Yang Xiaomei3

单位：1青海省妇女儿童医院麻醉科，西宁810001；2青海省妇女儿童医院骨科，西宁810001；3青海省妇女儿童医院康复科，西宁810001

英文单位：1Department of Anesthesiology Qinghai Province Women ＆ Children′s Hospital Xining 810001 China; 2Department of Orthopedics Qinghai Province Women ＆ Children′s Hospital Xining 810001 China; 3Department of Rehabilitation Qinghai Province Women ＆ Children′s Hospital Xining 810001 China

关键词：改良髂筋膜阻滞；全身麻醉；股骨骨折；中高海拔地区；血流动力学；苏醒质量

英文关键词：Modifiedfasciailiacacompartmentblock;Generalanesthesia;Femoralfracture;Mediumandhigh-altitudeareas;Hemodynamics;Recoveryquality

• 摘要：

• 目的 探讨改良髂筋膜阻滞联合全身麻醉对中高海拔地区小儿股骨骨折术中血流动力学及苏醒质量的影响。方法 选取2023年5月至2025年5月青海省妇女儿童医院收治的80例择期行股骨骨折手术患儿，采用随机数字表法分为对照组和观察组，各40例。对照组实施气管插管全身麻醉，观察组在对照组基础上联合髂筋膜间隙阻滞麻醉。记录2组术中麻醉药物使用量，以及患儿苏醒、拔管及麻醉监护室（PACU）停留时间。比较2组患儿不同时点［麻醉前（T0）、插管后5 min（T1）、切皮时（T2）、手术开始后30 min（T3）、术毕（T4）］的血流动力学指标（收缩压、舒张压和心率）。对比2组患儿不同时点（转出PACU、术后2 h、术后4 h、术后12 h）儿童疼痛行为量表（FLACC）评分。统计2组患儿不良反应发生情况。结果 随时间延长，2组患儿收缩压、舒张压、心率变化趋势不同，观察组变化趋势更小（均P＜0.05）。与对照组相比，观察组患儿术中丙泊酚、瑞芬太尼用量更少［（287±29）mg比（311±32）mg、（10.4±2.4）μg比（12.8±2.5）μg］（均P＜0.05）。与对照组相比，观察组转出PACU、术后2 h、术后4 h、术后12 h时的FLACC评分更低（均P＜0.05）；随时间延长，2组患儿FLACC评分先升高后降低，观察组变化趋势更小（P＜0.05）。与对照组相比，观察组患儿苏醒时间、拔管时间、PACU停留时间更短［（53±5）min比（57±5）min、（9±3）min比（12±3）min、（31±5）min比（35±5）min］（均P＜0.05）。2组患儿不良反应发生率差异均无统计学意义（均P＞0.05）。结论 改良髂筋膜阻滞联合全身麻醉对中高海拔地区股骨骨折患儿作用显著，有利于维持血流动力学稳定，减少麻醉药物用量，促进术后恢复，缩短苏醒时间，安全性较高。

• Objective To investigate the effects of modified fascia iliaca compartment block combined with general anesthesia on intraoperative hemodynamics and recovery quality in children with femoral fracture at medium and high altitudes. Methods A total of 80 children undergoing elective femoral fracture surgery admitted to Qinghai Province Women ＆ Children′s Hospital from May 2023 to May 2025 were selected and divided into control group and observation group by random number table method, with 40 cases in each group. The control group received tracheal intubation general anesthesia, and the observation group received combined fascia iliaca compartment block on the basis of the control group. The intraoperative dosage of anesthetics, awakening time, extubation time and length of stay in post-anesthesia care unit (PACU) were recorded in both groups. Hemodynamic indicators (systolic blood pressure, diastolic blood pressure and heart rate) at different time points ［before anesthesia (T0), 5 min after intubation (T1), skin incision (T2), 30 min after operation start (T3), end of operation (T4)］ were compared between the two groups. The behavioral pain scale for children (FLACC) scores at different time points (transfer out of PACU, 2 h, 4 h and 12 h after operation) were compared between the two groups. The incidence of adverse reactions was statistically analyzed. Results With time extension, the changing trends of systolic blood pressure, diastolic blood pressure and heart rate were different between the two groups, and the observation group showed a smaller changing trend (all P<0.05). Compared with the control group, the dosages of propofol and remifentanil in the observation group were lower ［(287±29)mg vs (311±32)mg, (10.4±2.4)μg vs (12.8±2.5)μg］(all P<0.05). Compared with the control group, the FLACC scores in the observation group were lower at transfer out of PACU, 2 h, 4 h and 12 h after operation (all P<0.05); with time extension, the FLACC scores in both groups first increased and then decreased, and the observation group showed a smaller changing trend (P<0.05). Compared with the control group, the awakening time, extubation time and PACU stay time in the observation group were shorter ［(53±5)min vs (57±5)min, (9±3)min vs (12±3)min, (31±5)min vs (35±5)min］(all P<0.05). There were no significant differences in the incidence of adverse reactions between the two groups (all P>0.05). Conclusions Modified fascia iliaca compartment block combined with general anesthesia has significant effects on children with femoral fracture at medium and high altitudes, which is conducive to maintaining hemodynamic stability, reducing the dosage of anesthetics, promoting postoperative recovery, shortening awakening time, with high safety.