髂筋膜间隙阻滞在小儿股骨干骨折中的应用  

Fascia iliaca compartment block in the operation of children with femur fractures

作　　者：王皓[1] 赵平[2] 赵广翊[2] 邢准[2] 

机构地区：[1]中国医科大学附属盛京医院,沈阳110004 [2]中国医科大学附属盛京医院麻醉科

出　　处：《中国医师杂志》2015年第3期376-379,共4页Journal of Chinese Physician

摘　　要：目的：评价髂筋膜间隙阻滞（ FICB）对小儿股骨干骨折术后早期镇痛效果，观察其对于患儿苏醒期躁动的影响，并与静脉芬太尼作比较。方法选择行单侧股骨干骨折手术患儿36例，经医院伦理委员会批准，分为髂筋膜间隙阻滞组（ FI组）及静脉芬太尼组（ FE组），每组18例。全麻诱导后，两组在超声引导下行髂筋膜间隙穿刺，FI组给予0．2％罗哌卡因（耐乐品）1 ml／kg，FE组给予生理盐水1 ml／kg，术中吸入七氟醚维持麻醉，手术结束前10 min，FE组给予1μg／kg芬太尼，FI组给予等体积生理盐水。术后拔管送入苏醒室（ PACU），记录两组患儿手术时间、拔管时间，术后送入PACU即刻（T0）、10 min（T1）、20 min（T2）的疼痛评分、小儿麻醉恢复期躁动评分（PAED）、PACU停留时间以及术后不良反应的发生情况。结果 T0、T1两时点，FI组疼痛评分低于FE组（ P ＜0．05）；T2时点，两组3-＜8岁患儿疼痛评分差异无统计学意义（ P ＞0．05 ），8-14岁患儿FI组疼痛评分低于FE组（ P ＜0．05）；与FE组相比，FI组三个时点PAED评分均降低，拔管时间及PACU停留时间明显缩短，差异有统计学意义（ P ＜0．05）。结论髂筋膜间隙阻滞能明显减轻小儿股骨干骨折术后苏醒期躁动评分和疼痛评分，效果优于静脉给予芬太尼。Objective To investigate the effect of fascia iliaca compartment nerve block （ FICB） to early analgesia and emergence agitation for children after the operation of femur fractures, and compare with fentanyl.Methods Totally 36 cases of children, which scheduled for the one-sided femur fractures surgery were selected after the approval from the Institutional Review Board of the hospital.They were randomly di-vided into two groups：FI group （ FICB group） and FE group （ Intravenous fentanyl group） .Patients in both groups were received ultrasound guided FICB immediately after the induction of general anesthesia, 1 ml/kg ropivacaine （ Naropin） was given in the FI group and 1 ml/kg saline in the FE group, sevoflurane was used for the anesthesia maintenance and 1 μg/kg intravenous fentanyl in FE group, instead of the same volume saline in FI group at 10 min before the surgery finished, and patients were sent to postanesthesia care unit （ PACU） after extubation.Keep a record of the duration of the operation and extubation, the pain scores and the Pediatric Agitation and Emergence Delirium （ PAED） scores were recorded at just arrived at PACU （ T0 ） , 10 min （ T1 ） , and 20 min （ T3 ） after PACU, also included the duration in PACU and the postopera-tively side effects.Results At the time of T0 and T1 , the pain scores in FI group was significantly lower than the FE（ P 〈0.05）, there was no difference between two groups from the age of 3 to 8 at T2 （ P 〉0.05）, but it was still lower in FI group from the age of 8 to 14（ P 〈0.05）;The PAED scores at the three time points were always lower in FI group when it was compared with FE group;the same trend occurred for the duration of extubation and PACU（ P 〈0.05）.Conclusions FICB can effectively reduce emergence agitation and the pain scores for the children undergoing the surgery of femur fractures during the early time＆amp;nbsp;after the operation, which is better than the intravenous fentanyl.

关 键 词：神经传导阻滞/方法 筋膜/外科学 髂骨 股骨骨折/外科学 镇痛 

分 类 号：R726.8[医药卫生—儿科]