经超声引导连续髂筋膜间隙阻滞用于高龄患者全髋关节置换术后镇痛的效果观察  

The efficacy of ultrasound-guided continuous iliac fascia space block for postoperative analgesia in elderly patients undergoing total hip replacement

作　　者：雷光磊 吴文知[1] 李培玉[1] 张兰[1] 吴贵云[2] 

机构地区：[1]四川省骨科医院麻醉科,四川成都610041 [2]中山医科大学孙逸仙纪念医院麻醉科,广东广州510120

出　　处：《实用医院临床杂志》2016年第2期114-117,共4页Practical Journal of Clinical Medicine

摘　　要：目的评价经超声引导下行髂筋膜间隙置管连续阻滞用于高龄患者全髋关节置换术后镇痛的安全性和有效性。方法拟行单侧全髋关节置换手术的高龄患者46例,采用随机数字表法分为A、B两组各23例。麻醉诱导前30 min在超声引导下,C组行单次髂筋膜间隙阻滞,T组行髂筋膜间隙置管连续阻滞。术毕C组患者行静脉PCA镇痛,T组经过术前留置导管行髂筋膜间隙连续阻滞镇痛。评估术后6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)各时点区域感觉阻滞情况、VAS评分和患肢运动阻滞改良Bromage评分、患者满意度、不良反应及镇痛补救情况。结果 T组T4、T5、T6时点不同区域感觉阻滞有效率高于C组,术后T5、T6时点静息及运动VAS评分低于C组,差异均有统计学意义(P<0.05),两组患肢运动阻滞改良Bromage评分在各时点差异均无统计学意义(P>0.05)。结论经超声引导下行髂筋膜间隙置管连续阻滞能为高龄全髋关节置换术患者术后提供安全和有效的镇痛效果,患者总体满意度高,不良反应少,并有利于患者的早期康复训练。Objective To evaluate the efficacy and safety of ultrasound-guided continuous iliac fascia space block（ c IFSB） for postoperative analgesia in elderly patients undergoing total hip replacement.Methods Forty-six patients scheduled for total hip replacement were randomly divided into c IFSB group（ Group T） and controlled intravenous analgesia（ PCIA） group（ Group C）,23 in each group.Both of the two group received ultrasound-guided continuous iliac fascia space block 30 min before surgery,but a catheter for c IFSB was remained in the group T.Then,the distribution of sensory block was assessed at the time of 15 min（ T1） and 30 min（ T2） after IFSB.The sensory block,pain（ VAS scale）,and motor（ modified Bromage scale） at the time of 6 h（ T3）,12 h（ T4）,24 h（ T5） and48 h（ T6） after the surgery,patient satisfaction scale,remedial analgesia treatment and adverse effects were assessed in all the patients.Results The group T had significantly lower VAS scores and lower rates of postoperative nausea and vomiting when compared to the group C at the time of T4,T5 and T6（ P〈 0. 05）.These patients were also significantly satisfied with c IFSB than PCIA.However,there was no significant difference in modified Bromage score between the two groups（ P〉0. 05）. Conclusion Ultrasound-guided c IFSB provides an effective and safe postoperative analgesia with less adverse effects for elderly patients undergoing total hip replacement.

关 键 词：髂筋膜间隙 神经阻滞 超声引导 高龄 髋关节置换 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学]