超声引导下连续髂筋膜间隙阻滞联合单次坐骨神经阻滞用于老年全膝关节置换术后镇痛的效果  

Effect of ultrasound-guided continuous fascia iliac compartment block combined with single sciatic nerve block for analgesia after total knee arthroplasty in elderly patients

作　　者：黄沾 王中胜[1] 侯建平 张运琼 袁毅 HUANG Zhan;WANG Zhongsheng;HOU Jianping;ZHANG Yunqiong;YUAN Yi(Department of Anesthesiology,Luzhou Traditional Chinese Medicine Hospital,Luzhou,Sichuan 646000,China;Department of Orthopaedics,Traditional Chinese Medicine Hospital Affiliated of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]泸州市中医医院麻醉科,四川泸州646000 [2]西南医科大学附属中医医院骨科,四川泸州646000

出　　处：《检验医学与临床》2019年第18期2644-2647,2650,共5页Laboratory Medicine and Clinic

摘　　要：目的评价超声引导下连续髂筋膜间隙阻滞联合单次坐骨神经阻滞在老年全膝关节置换术后的镇痛效果和安全性。方法选择2015年8月至2017年7月在泸州市中医医院拟行全膝关节置换术的老年患者56例,按随机数字表法分为E组和C组,每组28例。E组采用连续髂筋膜间隙阻滞联合单次坐骨神经阻滞镇痛,C组采用静脉自控镇痛;比较两组患者术后2、6、12、24、48h的静息视觉模拟评分(RVAS)与活动时视觉模拟评分(PVAS),术后48h内下肢肌力Bromage评分,术后补救镇痛率及不良反应发生率。结果两组术后6、12、24、48h的RVAS评分和PVAS评分与同组术后2h时比较均明显升高(P<0.05)。E组术后2、6、12、24、48h的RVAS评分和PVAS评分均显著低于C组(P<0.05)。E组在术后2h和6h的下肢肌力Bromage评分显著高于C组(P<0.05),两组术后6、12、24、48h的下肢肌力Bromage评分与同组术后2h比较明显降低(P<0.05)。与C组比较,E组术后补救镇痛率及头晕、恶心呕吐发生率降低(P<0.05)。结论超声引导下连续髂筋膜间隙阻滞联合单次坐骨神经阻滞能显著缓解膝关节置换患者术后疼痛,减少阿片类药物用量,不良反应少,有利于患者康复。Objective To evaluate the analgesic effect and safety of continuous fascia iliac compartment block combined with single sciatic nerve block of total knee arthroplasty under ultrasound guidance in elderly patients. Methods From August2015 to July2017,56 patients who planned to undergo total knee arthroplasty in Luzhou Traditional Chinese Medicine Hospital were divided into two groups according to the random number table method,every group had28 cases.The experimental group (group E) used continuous fascia iliac compartment block combined single sciatic nerve block analgesia (FICB+SNB),and control group (group C) used patient-controlled intravenous analgesia (PCIA).The resting visual analogue score (RVAS) and passive activity visual analogue score (PVAS),the Bromage score of lower limb muscle strength at2,6,12,24,48 h after operation,postoperative remedial digoxin dosage and the incidence of adverse reactions were compared between the two groups. Results RVAS scores and PVAS scores at 6,12,24,48 h after the operation were significantly higher than the 2 h after the operation in the same group ( P<0.05).RVAS scores and PVAS scores at2,6,12,24,48 h after the operation in group E were significantly lower than that of group C ( P<0.05 ).Bromage score in group E at2,6 h after operation were significantly higher than group C ( P<0.05).Bromage score at 6,12,24 and 48 h after the operation were significantly lower than that the 2 h after the operation in the same group ( P<0.05).Compared with the group C,the incidences of remedial analgesia and adverse reactions were significantly lower in group E ( P<0.05). Conclusion Ultrasound-guided continuous fascia iliac compartment combined with sciatic nerve block analgesia could significantly alleviate postoperative pain in elderly patients with total knee arthroplasty,reduce opioid dosage and adverse reactions,and facilitate the rehabilitation of patients.

关 键 词：超声引导 髂筋膜间隙 坐骨神经 全膝关节置换术 镇痛 

分 类 号：R614[医药卫生—麻醉学]