老年髋部骨折手术腰麻复合髂筋膜间隙阻滞镇痛效果的研究  

Study on analgesic effect of spinal anesthesia combined with fascia iliaca compartment block in the elderly undergoing hip fracture surgery

作　　者：傅小力 杨光 王利利[2] 原大江[2] FU Xiao-li;YANG Guang;WANG Li-li;YUAN Da-jiang(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学麻醉学系,山西省太原市030001 [2]山西医科大学第二医院麻醉科,山西省太原市030001

出　　处：《实用老年医学》2019年第12期1213-1216,共4页Practical Geriatrics

摘　　要：目的评估腰麻复合髂筋膜间隙阻滞在老年髋部骨折手术中的镇痛效果。方法回顾性分析2015~2016年接受手术治疗的419例70岁以上单侧髋部骨折病人的病例资料。按麻醉方式分为2组,S组为单纯腰麻组(282例),F组为超声下引导髂筋膜间隙阻滞后再行腰麻组(137例)。比较2组入手术室至手术前的时间段(T1)芬太尼使用量及收缩压(SBP)、舒张压(DBP)、心率(HR)最大变化率;比较2组术后24 h(T2)内入重症监护室(ICU)病人瑞芬太尼的用量、入骨科病房病人曲马多的用量及所有病人不良反应的发生情况。结果 F组在T1时间段芬太尼用量明显少于S组(P<0.05),SBP、DBP、HR最大变化率也明显少于S组(P<0.05);在T2时间段,F组入ICU病人瑞芬太尼药物用量、回骨科病房病人曲马多用量均明显少于S组(P<0.05);术后不良反应的发生率也低于S组(P<0.05)。结论腰麻复合髂筋膜间隙阻滞可减少术前阿片类药物的用量并有利于维持老年病人在术前血流动力学的稳定,减少术后阿片类药物的用量,减少不良反应,安全性高。Objective To evaluate the analgesic effect of spinal anesthesia combined with fascia iliaca compartment block in the elderly patients with hip fracture surgery.Methods A total of 419 patients with unilateral hip fractures over 70 years old who received surgical treatment from January 2015 to December 2016 were reviewed.According to the anesthesia method,they were divided into two groups.The patients in S group received simple spinal anesthesia(282 cases),while the patients in F group underwent ultrasound-guided fascia iliaca compartment block before spinal anesthesia(137 cases).The dosage of fentanyl during preoperative period(T1),the maximum rate of change in systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),the remifentanil dosage of patients in the intensive care unit,the dosage of tramadol for the patients in orthopedic ward during 24 h after surgery(T2) and the occurrence of adverse reactions were observed and compared between the two groups.Results Compared with S group,the dosage of fentanyl in T1 period in F group was significantly decreased(P < 0.05),and the maximum change rate of SBP,DBP and HR were also significantly decreased(P<0.05);In T2 period,the dosage of remifentanil of the patients in ICU was decreased(P<0.05),and the amount of tramadol of the patients in the orthopedic ward was decreased in F group compared with S group(P<0.05).The incidence rate of postoperative adverse reactions was also lower in F group than that of S group(P<0.05).Conclusions Spinal anesthesia combined with fascia iliaca compartment block can reduce the dosage of preoperative opioids and help to maintain the stability of preoperative hemodynamics in elderly patients,and reduce the dosage of postoperative opioids and the incidence of adverse reactions,with high security.

关 键 词：腰麻 髂筋膜间隙阻滞 髋部骨折手术 老年人 

分 类 号：R687.3[医药卫生—骨科学] R614.4[医药卫生—外科学]