髂筋膜间隙阻滞术后镇痛对老年股骨近端骨折患者应激水平及凝血功能的影响  

Effect of fascia iliaca compartment block on stress level and blood coagulation function in the elderly with proximal femoral fracture for postoperative analgesia

作　　者：黄锡强[1] 梁敬柱[1] 田野[1] 李斌飞[1] 

机构地区：[1]广东省中山市人民医院麻醉科,528403

出　　处：《中国现代医药杂志》2016年第2期1-5,共5页Modern Medicine Journal of China

基　　金：广东省中山市卫生和计划生育局医学科研立项课题(编号:2014J045)

摘　　要：目的评价超声引导下连续髂筋膜间隙阻滞术后镇痛对老年患者股骨近端骨折的镇痛效果及其对应激水平及凝血功能的影响。方法选取行股骨近端骨折手术老年患者60例,按术后镇痛方式随机分为两组,F组为超声引导下髂筋膜间隙阻滞镇痛组,I组为静脉镇痛组,评估两组患者术前及术后4h、12h、24h、48h静态和动态VAS评分,测定皮质醇(COR)、血糖(Glu)、血管紧张素Ⅱ、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)、D-二聚体水平,观察不良反应。结果 F组患者术后静态及动态VAS评分明显低于I组(P<0.05),而F组术后COR、Glu、血管紧张素Ⅱ水平也明显低于I组(P<0.05)。在术后24h,F组PT、APTT、TT较I组明显延长,Fib明显低于I组(P<0.05)。F组术后D-二聚体水平明显低于I组(P<0.05)。I组发生下肢深静脉血栓例数较F组多(P<0.05)。结论老年股骨近端骨折患者术后行超声引导下连续髂筋膜阻滞镇痛较静脉镇痛有更好的镇痛效果,能降低患者的应激水平,改善高凝状态。Objective To evaluate the effect of fascia iliaca compartment block on stress level and blood coagulation function in the elderly with proximal femoral fracture for postoperative analgesia. Methods 60 elderly patients with proximal femoral fracture surgery were randomly divided into the continuous fascia iliaca compartment block group （group F） and the continuous venous analgesia group （group Ⅰ） according to post-operative analgesia methods. Preoperative and 4h, 12h, 24h and 48h postoperatively static and dynamic VAS scoring were recorded. Determination of concentrations of cortisol（COR）, blood glu- cose （Glu）, angiotensin Ⅱ , prothrombin time（PT）, activated partial thromboplastin time（APTY）, thrombin time（TT）, fibrino- gen（Fib）, D-dimmer were performed. Adverse effect was recorded. Results Postoperative static and dynamic VAS scoring, COR, Glu,angiotensin Ⅱ in group F were significantly lower than those in group Ⅰ （P〈0.05）. PT, AISle, TT were significantly prolonged and Fib was lower at 24h postoperatively in group F than those in group Ⅰ （P〈0.05）. In comparison of the postopera- tively concentration of D-dimmer, group F was significandy lower than group Ⅰ （P〈0.05）. The number of deep venous thrombosis of the lower extremity in group Ⅰ was more than group F（P〈0.05）. Conclusion For postoperative analgesia in elderly patients after proximal femoral fracture surgery, ultrasound-guided continuous fascia iliaca compartment block has better analgesic ef- fect, lower stress level and improve coagulation state compared with continuous venous analgesia.

关 键 词：连续髂筋膜间隙阻滞 超声引导下 术后镇痛 应激 凝血功能 

分 类 号：R614[医药卫生—麻醉学]