全髋关节置换术后超声引导腹股沟韧带水平以上髂筋膜间隙阻滞与传统方法镇痛效果的比较  

A comparison of analgesic effects between ultrasound-guided supra-inguinal fascia iliaca compartment block and traditional method after total hip arthroplasty

作　　者：李振威[1] 冯宝莹[1] 张诚章[1] 余建华[1] 罗富荣[1] LI Zhenwei;FENG Baoying;ZHANG Chengzhang;YU Jianhua;LUO Furong(Department of Anesthesiology,Hospital of Traditional Chinese Medicine in Foshan city,Foshan,Guangdong 528000,China)

机构地区：[1]广东省佛山市中医院麻醉科,528000

出　　处：《重庆医学》2018年第28期3646-3649,共4页Chongqing medicine

基　　金：广东省佛山市卫生和计生局医学科研课题(20160008)

摘　　要：目的评价超声引导腹股沟韧带水平以上髂筋膜间隙阻滞(FICB)对全髋关节置换术(THA)患者术后镇痛的效果。方法择期行单侧外侧入路THA患者88例,采用随机数字表法将其分成2组(n=44):试验(TG)组患者术后30min内行超声引导纵向腹股沟韧带水平以上FICB;对照(CG)组术后30min内行超声引导腹股沟韧带水平处FICB。两组髂筋膜间隙均注射0.25%罗哌卡因共35mL,于术后3(T1)、6(T2)、12(T3)、24(T4)、48(T5)、72h(T6)的静息状态和运动状态检测视觉模拟评分(VAS);术后0~24、>24~48、>48~72h记录舒芬太尼消耗量;术后T2、T3、T4时刻评价股神经(FN)、闭孔神经(ON)和股外侧皮神经(LFCN)感觉阻滞情况;记录术后不良反应和患者满意度。结果与CG组比较,TG组各个时间段舒芬太尼消耗量减少(P<0.05),术后T3、T4静息状态和运动状态VAS评分降低(P<0.05),ON和LFCN感觉阻滞成功率高(P<0.05);患者满意度高(P<0.05)。结论超声引导腹股沟韧带水平以上FICB应用于THA的术后镇痛效果好,ON和LFCN感觉阻滞成功率高,患者满意度高。Objective To investigate the effect of ultrasound-guided fascia iliaca compartment block(FICB)above the level of supra-inguinalon in patients after total hip arthroplasty(THA).Methods Eighty-eight patients with THA who underwent unilateral lateral approach were randomly divided into two groups(n=44):ultrasound-guided FICB above the level of supra-inguinalon or traditional method was performed within 30 min after operation for the test group and the control group,respectively.All patients were received 35 mL of 0.25%ropivacaine.Sufentanil consumption was recorded at 0-24,>24-48,and>48-72 hours after surgery;the resting and motor state VAS scores at 3(T1),6(T2),12(T3),24(T4),48(T5),and 72(T6)hours after surgery were recorded.The femoral nerve,obturator nerve and lateral femoral cutaneous nerve block were evaluated at 6,12,and 24 hours after surgery.Results Compared with the control group,the consumption of sufentanil decreased at all time periods in the test group(P<0.05);the resting state and motor state VAS score decreased at 12 to 48 h after operation(P<0.05);and the success rate of obturator nerve and lateral femoral cutaneous nerve block were higher(P<0.05).Patient satisfaction in the test group was higher than that in the control group(P<0.05).Conclusion Ultrasound-guided FICB above the level of supra-inguinal is effective methods in the postoperative analgesia of THA,which has a high success rate of obturator nerve and lateral femoral cutaneous nerve block and patient satisfaction.

关 键 词：髂骨 筋膜 神经传导阻滞 超声检查 多普勒 彩色 关节成形术 置换 髋 镇痛 

分 类 号：R614.4[医药卫生—麻醉学]