B超引导下髂筋膜间隙阻滞对老年股骨近端骨折患者术后疼痛及并发症的影响  

Effect of postoperative pain and complications on the B-ultrasound guided fascia iliaca compartment block for the elderly patients with proximal femur fracture

作　　者：苘莲萍[1] 邱斐斐[1] 陈小涛[1] QING Lian-ping;QIU Fei-fei;CHEN Xiao-tao(Dept of Anesthesiology,Wendeng Osteopathy Hospital,Weihai,Shandong264400,China)

机构地区：[1]文登整骨医院麻醉科,山东威海264400

出　　处：《临床骨科杂志》2018年第2期215-217,220,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨B超引导下髂筋膜间隙阻滞(FICB)对老年股骨近端骨折患者术后疼痛及并发症的影响。方法选取100例老年股骨近端骨折术后患者,随机分为阻滞组和静脉组,每组50例。静脉组给予静脉镇痛(0.02 mg/kg芬太尼+500 mg曲马多)治疗,阻滞组在静脉组基础上给予B超引导下FICB(0.125%布比卡因+0.02 mg/kg芬太尼)治疗。结果阻滞组术后6、12、24 h的疼痛VAS评分明显低于静脉组,差异有统计学意义(P<0.01)。阻滞组术后24 h血清纤维蛋白原、D-二聚体、白介素-6、肿瘤坏死因子α水平明显低于静脉组,差异均有统计学意义(P<0.01)。阻滞组并发症发生率及胃肠道蠕动恢复、下床活动、住院的时间明显少于静脉组,差异均有统计学意义(P<0.05,P<0.001)。结论 B超引导下FICB可有效缓解老年股骨近端骨折患者术后疼痛,减少高凝、炎性等应激反应及并发症的发生,有利于患者术后康复。Objective To investigate the effect of postoperative pain and complications on the B-ultrasound guided fascia iliaca compartment block(FICB)for the elderly patients with proximal femur fracture.Methods The 100 elderly patients with proximal femur fracture were selected,according to the random distribution,all patients were divided into block group and vein group,50 cases in each group,vein group was given vein analgesic(0.02 mg/kg fentanyl+500 mg tramadol)treatment;on the basis of vein group,block group was given B-ultrasound guided FICB(0.125%bupivacaine+0.02 mg/kg fentanyl)treatment.Results The postoperative 6,12,24 h pain VAS of block group were significantly lower than those of vein group,the differences were statistically significant(P<0.01).The postoperative serum fibrinogen,D-dimer,interleukin 6,tumor necrosis factor alpha levels of block group were significantly lower than those of vein group,the differences were statistically significant(P<0.01).The complication incidence rate and gastrointestinal peristaltic recovery,getting out of bed,hospitalization time of block group were significantly lower than those of vein group,the differences were statistically significant(P<0.05,P<0.001).Conclusions B-ultrasound guided FICB can effectively relieve the postoperative pain in elderly patients with proximal femoral fracture,it is beneficial to decrease the high coagulation and inflammatory stress response and the occurrence of complications,and it is helpful to the postoperative rehabilitation of patients.

关 键 词：B超引导 髂筋膜间隙阻滞 股骨近端骨折 手术后疼痛 老年人 

分 类 号：R683.42[医药卫生—骨科学] R614.4[医药卫生—外科学]