连续髂筋膜阻滞和硬膜外阻滞下行全髋置换后镇痛的比较  

Analgesic effects of continuous fascia iliaca compartment block versus continuous epidural analgesia after total hip arthroplasty

作　　者：孙晓娟[1] 张红星[1] 董补怀[1] 李靖[1] 吴绪才[1] 肖莉[1] 张晗[1] 蔡亮[1] 王强[1] 

机构地区：[1]西安交通大学附属红会医院麻醉科,陕西省西安市710054

出　　处：《中国组织工程研究》2014年第31期4934-4938,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:硬膜外持续镇痛曾被认为是下肢术后镇痛的金标准,其效果确切,全身不良反应较少,临床上普遍采用。但此法有低血压及尿潴留等不良反应,且患者在术后常规需应用低分子肝素抗凝,有增加硬膜外血肿的可能性,限制了硬膜外镇痛的临床使用。目前超声引导下连续髂筋膜腔隙阻滞技术的相关研究报道甚少。目的:评价连续髂筋膜间隙阻滞和连续硬膜外阻滞两种不同镇痛方法对全髋关节置换后镇痛效果和关节功能恢复的影响。方法:将60例择期行全髋关节置换患者分为2组:连续髂筋膜间隙阻滞组和连续硬膜外镇痛组(n=30)。两组患者在全身麻醉诱导前均接受预注量,连续髂筋膜间隙阻滞组经髂筋膜间隙注入0.25%罗哌卡因30 mL,连续硬膜外阻滞组经硬膜外导管注入0.20%罗哌卡因10 mL,均留置导管。待镇痛效果明确后,全麻插管。术毕两组分别经髂筋膜间隙、硬膜外连接镇痛泵持续给药,未使用术后自控镇痛单次给药。若疼痛难以忍受时,视其疼痛程度,予补救镇痛(帕瑞昔布20-40 mg/次)。记录目测类比评分、帕瑞昔布补救剂量、麻醉并发症、髋关节Harris评分、下床时间和住院时间。结果与结论:目测类比评分、额外追加的镇痛药量、Harris评分、住院日两组无明显差别。但是下床时间连续髂筋膜间隙阻滞组早于连续硬膜外阻滞组,而且连续髂筋膜间隙阻滞组并发症明显低于连续硬膜外阻滞组。提示全髋关节置换后,两种镇痛方式均可提供满意的术后镇痛效果,髋关节功能可得到良好的恢复;但连续髂筋膜间隙阻滞并发症少且有利于患者早期下床活动,对于髋关节置换后镇痛是更好的选择。BACKGROUND：Epidural analgesia has been considered a gold standard for postoperative analgesia in the lower limbs. Its outcomes are accurate and adverse reactions are few, so it can be used in the clinic. However, this method has adverse reactions such as hypotension and urine retention. Low molecular weight heparin should be used after operation, which can increase the possibility of epidural hematoma, and limits its application to epidural analgesia in the clinic. At present, few studies concerned ultrasound guided continuous fascia iliaca compartment block technology. OBJECTIVE：To evaluate the efficacy of postoperative pain relief and the joint rehabilitation between a continuous fascia iliaca compartment block and a continuous epidural analgesia for patients undergoing total hip arthroplasty. METHODS：A total of 60 patients undergoing a selective total hip arthroplasty were assigned to continuous fascia iliaca compartment block group and continuous epidural analgesia group （n=30）. Al patients in both groups＆amp;nbsp;received a pre-fluence before general anesthesia. Continuous fascia iliaca compartment block group were injected with 0.25%ropivacaine 30 mL via iliac fascia gap. Continuous epidural analgesia group received 0.20%ropivacaine 10 mL via epidural catheter, indwel ing catheter. When the analgesic effect was identified, anesthesia intubation was carried out. After operation, medicine was given via iliac fascia and epidural analgesia pump in both groups respectively. Postoperative analgesia in single dose was not given. If pain could not be endured, analgesia would be rescued （parecoxib 20-40 mg/time） according to pain degree. Visual analogue scale scores, supplemental analgesia of parecoxib, complication of anesthesia, Harris hip joint scores, day of first walk, and duration of hospital stay were recorded. RESULTS AND CONCLUSION：No significant difference in visual analogue scale scores, supplemental analgesia, Harris hip joint scores and duration of hospital stay was detected. Day of

关 键 词：植入物 人工假体 连续硬膜外阻滞 连续髂筋膜间隙阻滞 全髋关节置换 镇痛 

分 类 号：R318[医药卫生—生物医学工程]