连续髂筋膜间隙阻滞术用于老年人股骨骨折椎管内麻醉前摆放体位及术后镇痛的效果观察  

Appfication of continuous lilac fascial interstitial obstruction in the placement of anaesthesia in the vertebral canal of the elderly femoral fractures and postoperative analgesia

作　　者：金理照 丁梯杰 黄美华[1] 陈香环 Jin Lizhao;Ding Tijie;Huang Meihua;Chen Xianghuan.(Department of Anesthesiology,the People＇s Hospital of Cangnan County,Zhejiang 325800, Chin)

机构地区：[1]浙江省苍南县人民医院麻醉科,325800

出　　处：《中国基层医药》2018年第9期1121-1125,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市科技计划项目（Y20160386）

摘　　要：目的 探讨连续髂筋膜间隙阻滞术用于老年股骨骨折患者椎管内麻醉前摆放体位及术后镇痛的效果.方法 择老年单侧股骨骨折患者60例,年龄68～87岁,体质量49～70 kg,ASA分级Ⅱ～Ⅲ级,采用随机数字表法分为髂筋膜间隙阻滞组（A组,n=30）和静脉药物镇痛组（B组,n=30）,A、B两组均行腰-硬联合麻醉,A组于摆放体位15 min前行连续髂筋膜间隙阻滞术.B组常规腰-硬联合麻醉.术毕,A组连接全自动注液泵,持续输注0.2％罗派卡因0.1 mL·kg-1·h-1.B组患者自控静脉镇痛,术后给予负荷量地佐辛5 mg静脉滴注,用自动注射泵持续输注地佐辛0.01 mg·kg-1·h-1.分别对患者在入室时（T0）和刚摆放体位后（T1）的心率、舒张压以及收缩压进行测量并记录,记录术后2、4、6、12、24和48 h时间点患者的VAS评分以及手术过程中哌替啶的使用量及患者是否出现不良反应.结果 A组T1时刻的心率、舒张压以及收缩压较T0无明显增高（P〉0.05）.而B组T1时刻的心率、舒张压以及收缩压较T0明显增高（t心b=5.302,t舒b=7.369,t收b=5.629,P〈0.05）,A组T1、T2、T4、T6、T12、T24、T48时间点疼痛VAS评分低于B组相应各个时间点（t1=66.401,t2=7.719,t4=25.260,t6=13.170,t12=3.837,t24=3.081,t48=6.202,均P〈0.05）,A组未发生穿刺血肿、局麻药中毒等并发症.结论 连续髂筋膜间隙阻滞可为老年股骨骨折患者提供持续镇痛,安全有效,执行简便,为后期手术治疗提供有利条件.Objective To investigate the effect of continuous iliac fascia space block on the placement of body position and postoperative analgesia in patients with femoral fractures. Methods 60 patients with senile selective unilateral femoral fracture, aged 68 - 87 years old, weight 49 - 70kg, ASA grade II -III were selected, and they were randomly divided into iliac fascia block group （ A group） and intravenous analgesia group （ B group） according to the digital, 30 cases in each group. The two groups underwent lumbar epidural anesthesia, A group received continuous fascia iliaca compartment block 15 min before the the body position. B group was routinely given combination of lumbar and hard anesthesia. After operation, A group was connected with the automatic infusion pump continuous infusion of 0.2% ropivacaine 0. 1mL · kg-1 · h-1. B group received controlled intravenous analgesia, postoperative given loading dose of dezocine intravenous infusion of 5mg with automatic injection pump for dezocine 0. 01mg · kg-1 · h-1. When the patients entered the room （TO） and just after the placement of the body position （TI） ,the heart rate, diastolic blood pressure and systolic blood pressure were measured and recorded. At postoperative 2,4,6, 12,24 and 48h, the VAS scores and pethidine usage during surgery, the adverse reaction were recorded. Results The heart rate, diastolic pressure and systolic pressure at T1 in A group had no significant change compared with TO （all P 〉 0.05）. The heart rate, diastolic pressure and systolic pressure in the control group （B group） at T1 were significantly higher than at TO（ t = 5. 302,7. 369,5. 629, all P 〈 0.05 ）. At T1, T2, T4, T6, T12, T24 and T48,the pain VAS scores in A group were lower than those in B group （t~ = 66. 401, t2 = 7. 719, t4 = 25. 260, t6 = 13. 170, t12 = 3. 837,t24 = 3. 081,t4s = 6. 202. all P 〈 0.05 ）. The study group had no complications such as puncture hematoma, intoxication of local anesthetic and other complications. Conclusion

关 键 词：髂筋膜间隙阻滞 股骨骨折 老年人 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]