麻醉方式对髋关节置换患者术后谵妄和镇痛效果的影响  

Effect of general anesthesia combined with iliac fascial compartment block on postoperative delirium and analgesia after total hip arthroplasty

作　　者：秦洪猛 王星 司海超[1] 欧阳晟[2] QIN Hong-meng;WANG Xing;SI Hai-chao;OUYANG Sheng(Department of Anesthesiology,Nanyang Central Hospital,Nanyang 473000,China;Department of Anesthesiology,Nanyang Orthopaedic Hospital,Nanyang 473000,China;Orthopedic Department,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]河南南阳市中心医院麻醉科,473000 [2]河南南阳市中心医院骨三科,473000 [3]河南南阳市骨科医院麻醉科,473000

出　　处：《中国矫形外科杂志》2020年第11期903-908,共6页Orthopedic Journal of China

摘　　要：[目的]探讨全身麻醉结合髂筋膜间隙阻滞对髋关节置换患者术后谵妄及镇痛效果的影响。[方法]选择2015年1月~2019年1月,本院实施THA的480例患者,ASAⅠ~Ⅲ级,年龄45~75岁,随机分为两组。其中,228例在全身麻醉联合髂筋膜间隙阻滞下行THA(试验组),其余252例在单纯全身麻醉下行手术(对照组)。比较两组患者围手术期临床指标、术后谵妄情况及DRS评分、VAS评分和下肢肌力。[结果]两组患者在麻醉时间、手术时间、术中出血量、HR、MAP、SpO2等方面差异无统计学意义(P>0.05)。术后24 h和48 h,试验组在CAM-ICU标准评定的术后谵妄发生、镇痛泵按压次数、VAS评分方面均显著优于对照组,差异有统计学意义(P<0.05);但相应时间点两组间DRS评分的差异无统计学意义(P>0.05)。此外,两组患者术后相应时间点股四头肌和髂腰肌肌力差异无统计学意义(P>0.05)。[结论]超声引导下的髂筋膜神经阻滞联合全身麻醉能够减少THA后POD的发生率,显著缓解术后疼痛,有利于患者快速康复。[Objective]To compare the postoperative delirium(POD)and analgesia secondary to general anesthesia combined with or without iliac fascial compartment block for total hip arthroplasty(THA).[Methods]From January 2015 to January 2019,480 patients who aged 45~75 years and were undergoing THA in our hospital,were randomly divided into two groups.Of them,228 patients had THA performed under general anesthesia combined with iliac fascial compartment block(the trial group),while the remaining 252 patients received THA under general anesthesia only(the control group)The perioperative clinical data,occurrence of POD and DRS score,as well as VAS score and lower limb muscle strength were compared between the two groups.[Results]There was no significant difference regarding anesthesia time,operation time,intraoperative bleeding,HR,MAP and SpO2 at corresponding time points between the two groups(P>0.05).The trial group proved significantly superior to the control group in occurrence of POD by CAM-ICU criteria,the times of pressing analgesic pump,cumulated dosage of sufentanil and VAS scores at 24 and 48 hours postoperatively(P<0.05),regardless of no statistical differences between them in DRS score at any matching time point(P>0.05).In addition,there was no significant difference in muscle strength of quadriceps femoris and iliopsoas at any corresponding time point between the two groups(P>0.05).[Conclusion]This ultrasoundguided iliac fascial compartment block combined with general anesthesia does reduce the occurrence of postoperative delirium and significantly enhance postoperative analgesia,which facilitate the rapid recovery after total hip arthroplasty.

关 键 词：髂筋膜神经阻滞 全身麻醉 髋关节置换术 术后谵妄 镇痛 

分 类 号：R687.4[医药卫生—骨科学]