摘要
目的分析椎管内麻醉联合超声引导下髂筋膜阻滞(FIB)在髋部骨折手术中的应用研究。方法选择驻马店市中心医院2021年10月至2024年11月收治的98例髋部骨折患者进行前瞻性研究,采用随机数表法分为观察组和对照组,每组各49例。对照组采用椎管内麻醉,观察组采用超声引导下FIB联合椎管内麻醉。比较两组患者疼痛情况[(术后24 h及48 h的视觉模拟评分法(VAS)评分、48 h内首次静脉自控镇痛按压时间、静脉自控镇痛次数、补救镇痛次数)]、术后24 h及48 h的舒适度评分及15项恢复质量评分量表(QoR-15)评分、术前及术后24 h的血糖及皮质醇水平、术后不良反应发生率。结果观察组患者术后24 h及48 h的VAS评分分别为(3.29±0.75)分、(3.40±0.61)分,均低于对照组的(3.91±0.88)分、(3.95±0.71)分,观察组镇痛泵首次按压时间为(6.02±1.02)h,晚于对照组的(4.70±0.81)h,观察组镇痛泵按压次数及补救镇痛次数分别为(4.40±0.93)次、(2.17±0.55)次,少于对照组的(8.73±1.10)次、(4.59±0.71)次,以上差异均有统计学意义(P<0.05)。观察组患者术后24 h及48 h的舒适度评分分别为(3.05±0.31)分、(3.10±0.21)分,高于对照组的(2.60±0.34)分、(2.71±0.30)分,观察组24 h及48 h的QoR-15评分分别为(113.87±7.41)分、(116.08±8.15)分,高于对照组的(101.28±9.10)分、(105.97±7.40)分,差异均有统计学意义(P<0.05)。观察组患者术后24 h血糖为(7.40±1.14)mmol/L,低于对照组的(8.32±1.55)mmol/L,差异有统计学意义(P<0.05);观察组患者术后24 h皮质醇为(251.06±24.27)nmol/L,低于对照组的(296.01±25.60)nmol/L,差异有统计学意义(P<0.05)。观察组患者不良反应发生率为6.12%,明显低于对照组的24.49%,差异有统计学意义(P<0.05)。结论超声引导下FIB联合椎管内麻醉能够减少髋部骨折患者术后疼痛,提升患者术后舒适度及恢复质量,减少皮质醇及血糖波动,降低不良反应发生率。
Objective To analyze the application of intraspinal anesthesia combined with ultrasound-guided fascia iliaca block(FIB)in hip fracture surgery.Methods A total of 98 patients with hip fractures admitted to Zhumadian Central Hospital from October 2021 to November 2024 were selected for a prospective study and randomly divided into an observation group and a control group using a random number table method,with 49 cases in each group.Patients in the control group received intraspinal anesthesia,while those in the observation group received ultrasound-guided FIB combined with intraspinal anesthesia.The pain conditions(visual analogue scale[VAS]scores at 24 h and 48 h after surgery,time of the first press of patient-controlled intravenous analgesia[PCIA]within 48 h,frequency of PCIA presses,frequency of rescue analgesia),comfort scores and 15-item Quality of Recovery Score Scale(QoR-15)scores at 24 h and 48 h after surgery,preoperative and postoperative(24 h)blood glucose and cortisol levels,and the incidence of postoperative adverse reactions were compared between the two groups.Results The VAS scores in the observation group at 24 h and 48 h after surgery were(3.29±0.75)points and(3.40±0.61)points,respectively,which were both lower than(3.91±0.88)points and(3.95±0.71)points in the control group;the time to the first press of the analgesia pump in the observation group was(6.02±1.02)h,which was later than(4.70±0.81)h in the control group;the number of analgesia pump presses and rescue analgesia times in the observation group were(4.40±0.93)times and(2.17±0.55)times,respectively,fewer than(8.73±1.10)times and(4.59±0.71)times in the control group;the differences were statistically significant(all P<0.05).The comfort scores in the observation group at 24 h and 48 h after surgery were(3.05±0.31)points and(3.10±0.21)points,respectively,which were higher than(2.60±0.34)points and(2.71±0.30)points in the control group;the QoR-15 scores in the observation group at 24 h and 48 h were(113.87±7.41)points and(116.08±8.15)points,respectively,which were also higher than(101.28±9.10)points and(105.97±7.40)points in the control group;the differences were statistically significant(all P<0.05).The blood glucose level of patients in the observation group at 24 h after surgery was(7.40±1.14)mmol/L,which was lower than(8.32±1.55)mmol/L of the control group(P<0.05);the cortisol level of patients in the observation group at 24 h after surgery was(251.06±24.27)nmol/L,which was lower than(296.01±25.60)nmol/L of the control group(P<0.05).The incidence of adverse reactions in the observation group was 6.12%,which was significantly lower than 24.49%in the control group(P<0.05).Conclusion Ultrasound-guided FIB combined with intravertebral anesthesia can reduce postoperative pain,improve postoperative comfort and recovery quality of patients,reduce cortisol and blood glucose fluctuation,and reduce the incidence of adverse reactions in patients with hip fractures.
作者
吴黎生
王震
WU Li-sheng;WANG Zhen(Department of Anesthesiology,Zhumadian Central Hospital,Zhumadian 463000,Henan,CHINA)
出处
《海南医学》
2026年第3期378-382,共5页
Hainan Medical Journal
基金
河南省医学科技攻关计划联合共建项目(编号:LHGJ20191723)。
关键词
髋部骨折
超声引导
髂筋膜阻滞
椎管内麻醉
Hip fracture
Ultrasound-guided
Fascia iliaca block
Intraspinal anesthesia
作者简介
第一作者:吴黎生(1980-),男,副主任医师,主要研究方向为临床麻醉;通信作者:王震(1979-),男,副主任医师,主要研究方向为临床麻醉,E-mail:wzake1979@163.com。
