摘要
目的 观察超声引导下腹股沟韧带上髂筋膜间隙阻滞在老年全髋关节置换术患者围术期中的镇痛效果。方法 将105例行全髋关节置换术的非急性骨折老年患者随机均分为腹股沟韧带处髂筋膜间隙阻滞组(I组)、腹股沟韧带上髂筋膜间隙阻滞组(S组)和对照组(C组)。分别于阻滞后10、20、30 min时测量阻滞侧大腿内收肌肌力。观察患者入室、切皮、击打假体、术毕时的MAP和HR变化。分别于术后2、4、6、12、24 h时采用VAS疼痛评分评估患者疼痛程度。记录术中舒芬太尼和雷米芬太尼使用量、术后48 h内静脉患者自控镇痛(PCA)有效按压次数、术后并发症发生情况以及患者疼痛总满意度。结果 与C组相比,I组和S组在阻滞后10、20、30 min时大腿内收肌肌力评分降低,在切皮、击打假体、术毕时MAP和HR降低,术后2、4、6、12、24 h时VAS疼痛评分降低,舒芬太尼和雷米芬太尼使用量、静脉PCA有效按压次数以及苏醒后躁动、恶心呕吐发生率减少(P<0.05),其中S组降低程度更加明显(P<0.05)。C组、I组、S组患者疼痛总满意度依次升高(P<0.05)。结论 超声引导下腹股沟韧带上髂筋膜间隙阻滞对老年全髋关节置换术患者的镇痛效果显著,维持术中循环稳定,减少并发症发生,提高患者满意度。
Objective To investigate the perioperative analgesic efficacy of ultrasound-guided supra-inguinal ligament iliaca fascia block(IFB) in elderly patients undergoing total hip replacement(THR).Methods A total of 105 elderly patients with non-acute fractures undergoing THR were equally divided into three groups of I(with inguinal ligament IFB),S(with supra-inguinal ligament IFB) and C(blank control).The adductor muscle strength of the thigh on the block side was measured at the 10^(th),20^(th) and 30^(th) minute after block.The changes of MAP and HR were observed after entering the operation room, skin incision, beating the prosthesis and at the end of operation.The pain degree was evaluated by VAS pain score in the 2^(nd),4^(th),6^(th),12^(th) and 24^(th) hour after operation.The intraoperative consumptions of sufentanil and remifentanil, effective pressing number of intravenous patient-controlled analgesia(PCA) within 48 hours after operation, postoperative complication and analgesic satisfaction of the patients were recorded.Results Compared with group C,the adductor muscle strength of the thigh on the block side was decreased at the 10^(th),20^(th) and 30^(th) minute after block, the MAP and HR were decreased after entering the operation room, skin incision, beating the prosthesis and at the end of operation, the VAS pain scores were decreased in the 2nd,4th,6th,12thand 24thhour after operation, and the consumptions of sufentanil and remifentanil, effective PCA number and the incidences of dysphoria after waking up and nausea and vomiting were decreased in groups of I and S(P<0.05),which were lower in group S than those in group I(P<0.05).The increase of total pain satisfaction of the patients was in an order of group S >group I >group C(P<0.05).Conclusion Ultrasound-guided supra-inguinal ligament IFB has an obvious analgesic efficacy in the elderly patients undergoing THR with better intraoperative circulation stability, less complications and higher patients’ satisfaction.
作者
王立萍
朱忠权
张宇帆
WANG Liping;ZHU Zhongquan;ZHANG Yufan(Department of Anesthesiology,Jinhua Central Hospital,Jinhua 321000,CHINA)
出处
《江苏医药》
CAS
2022年第12期1234-1238,F0003,共6页
Jiangsu Medical Journal
基金
金华市科学技术研究计划项目(2020-4-004)。
关键词
髂筋膜阻滞
全髋关节置换术
镇痛
老年
Iliac fascia block
Total hip replacement
Analgesia
Geriatrics
作者简介
通信作者:张宇帆,E-mail:349198750@qq.com。
