超声引导下连续腰丛神经阻滞在老年髋部骨折患者术后镇痛的临床效果  

Clinical effects of postoperative analgesia with ultrasound-guided continuous lumbar plexus block inelderly patients with hip fracture

作　　者：赵丽艳[1] 张卫[1] 陈可新[2] 康定坤[3] 

机构地区：[1]郑州大学第一附属医院麻醉科,450052 [2]河南省洛阳正骨医院骨科,471002 [3]河南省洛阳正骨医院麻醉科,471002

出　　处：《实用疼痛学杂志》2015年第4期274-278,共5页Pain Clinic Journal

摘　　要：目的观察超声引导下连续腰丛神经阻滞应用于老年患者髋部骨折术后镇痛的临床效果。方法择期拟行单侧髋部骨折手术的老年患者60例，随机分为超声引导下连续腰丛神经阻滞镇痛组（A组）和静脉镇痛组（B组），每组各30例。所有患者均在腰麻下完成手术，术毕A组患者在超声引导下腰丛神经置管，行连续腰丛神经阻滞镇痛；B组患者行持续静脉镇痛。观察并记录所有患者术后4、8、12、24、48h时视觉模拟评分，0～12、12～24、24～48h期间PCA次数和使用帕瑞昔布钠的剂量，记录并发症和不良反应的发生情况，评价患者对术后镇痛的满意度。结果B组术后8、12、24、48h时VAS评分比A组相应时点高，在术后0—12h、12～24h、24～48h期间PCA次数和使用帕瑞昔布钠的剂量多于A组（P〈0．05）；A组不良反应发生率为3％，明显低于B组（37％）（P〈0．05）；患者满意度为97％，明显高于B组（83％）（P〈0．05）。结论超声引导下连续腰丛神经阻滞应用于老年患者髋部骨折术后镇痛效果确切，不良反应发生率低，患者满意度高。Objective To observe the postoperative analgesia effects of ultrasound-guided continuous lumbar plexus block in elderly patients with hip fracture. Methods Sixty elderly patients scheduled for unilat- eral hip fracture surgery were randomly divided into the ultrasound-guided continuous lumbar plexus block group（group A）and intravenous analgesia group （group B）, 30 cases in each group. The operations were under- gone with spinal anesthesia in all patients. Catheters were placed around lumbar plexus under ultrasonic guid- ance and continuous lumbar plexus block were used for postoperative analgesia in group A, and continuous in- travenous postoperative analgesia were used in group B. Visual analogue scale （VAS） at 4,8,12,24,48 h after the operation and the PCA times and the dosage of parecoxib sodium during 0-12 h, 12-24 h, 24-48 h after the operation were observed and recorded. The incidence of complications and adverse reactions were recorded and the rates of patient satisfaction were evaluated. Results VAS at 8,12,24,48 h after the operation in group B were higher than that in group A, and both the PCA times and the dosage of parecoxib sodium in group B were more than those in group A during 0-12 h, 12-24 h, 24-48 h after the operation （P 〈 0.05）. The incidence of ad- verse reactions in group A was 3%, which was significantly lower than that in group B （37%, P 〈 0.05）. The rate of patient satisfaction in group A was 97%, which was significantly higher than that in group B （83%, P〈 0.05）. Conclusion Ultrasound-guided continuous lumbar plexus block used for postoperative analgesia in elderly patients with hip fracture is effective with lower incidence of adverse reactions and higher rates of patient satis- faction.

关 键 词：超声检查 腰丛神经 神经传导阻滞 髋部骨折 镇痛 老年人 

分 类 号：R971.2[医药卫生—药品]