不同镇痛方式对髋部骨折患者蛛网膜下腔阻滞体位摆放时镇痛效果的比较  

Effects of different analgesia regimens in patients with hip fracture during posture changing

作　　者：单子宝 黄辉[2] 厉建 李慧[1] 魏代梅 袁莉[2] SHAN Zibao;HUANG Hui;LI Jian;LI Hui;WEI Daimei;YUAN Li(Department of Anesthesiology,Rizhao Hospital of Traditional Chinese Medicine,Jining Medical University,Rizhao 276800,Shandong,China)

机构地区：[1]济宁医学院附属日照市中医医院麻醉科,山东日照276800 [2]青岛大学附属医院麻醉科 [3]五莲县中医医院麻醉科

出　　处：《上海医学》2020年第12期720-723,共4页Shanghai Medical Journal

基　　金：济宁医学院教师科研扶持基金(JYFC2019FKJ063)。

摘　　要：目的比较单纯的静脉镇痛、髂筋膜间隙阻滞镇痛和静脉镇痛复合髂筋膜间隙阻滞镇痛用于髋部骨折患者麻醉体位变动时的镇痛效果。方法选择行髋部骨折手术患者90例,采用随机数字表法分为静脉镇痛组(静脉组)、髂筋膜间隙阻滞镇痛组(阻滞组)、静脉镇痛复合髂筋膜间隙阻滞镇痛组(复合组)3组,每组30例。静脉组给予舒芬太尼10μg静脉注射,3 min后搬动患者摆放麻醉体位。阻滞组于超声引导下行改良髂筋膜间隙阻滞,给予0.375%罗哌卡因30 mL,感觉阻滞完善后搬动患者摆放麻醉体位。复合组于髂筋膜间隙阻滞前给予舒芬太尼10μg静脉注射,感觉阻滞完善后搬动患者摆放麻醉体位。记录入手术室后(T 0)、搬动前(T 1,静脉组静脉注射舒芬太尼3 min后,阻滞组和复合组感觉阻滞完善后)、蛛网膜下腔阻滞穿刺前变换体位时(T 2)、麻醉穿刺成功改为平卧位后3 min时(T 3)患者的疼痛VAS评分。记录髂筋膜间隙阻滞操作时间、髂筋膜间隙阻滞完善时间、蛛网膜下腔阻滞时间,以及镇痛期间呼吸抑制的发生情况。结果3组间T 0时间点的疼痛VAS评分的差异均无统计学意义(P值均>0.05)。静脉组T 1、T 3时间点的疼痛VAS评分均显著低于同组T 0时间点(P值均<0.05),T 2时间点的疼痛VAS评分显著高于同组T 0时间点(P<0.05);阻滞组和复合组T 1至T 3时间点的疼痛VAS评分均显著低于同组T 0时间点(P值均<0.05)。阻滞组和复合组T 1、T 2时间点的疼痛VAS评分均显著低于静脉组同时间点(P值均<0.05),复合组T 2时间点的疼痛VAS评分显著低于阻滞组同时间点(P<0.05)。阻滞组与复合组间髂筋膜间隙阻滞操作时间的差异无统计学意义(P>0.05),复合组髂筋膜间隙阻滞完善时间显著短于阻滞组(P<0.05),3组间蛛网膜下腔阻滞时间的差异无统计学意义(P值均>0.05)。静脉组、阻滞组、复合组的呼吸抑制发生率分别为20.0%(6/30)、0、3.3Objective To investigate the effects of different analgesia regimens in patients with hip fracture during posture changing.Methods Ninety patients with hip fracture were randomly divided into three groups(n=30):intravenous group(group V),fascia iliaca compartment block group(group F)and intravenous combined with fascia iliaca compartment block group(group C).Sufentanil(10μg)was injected intravenously 3 min before anaesthesia position adjustment in group V.The patients in group F received modified fascia iliaca compartment block using ultrasound-guided injection of 0.375%ropivacaine 30 mL.In group C,sufentanil(10μg)was injected intravenously 3 min before nerve block.VAS scores were recorded after entering operation room(T 0),before transposition(T 1,3 min after intravenous sufentanil injection in group V,and after complete block in group F and C),before subarachnoid anaesthesia(T 2),and 3 min after successful subarachnoid anaesthesia in supine position(T 3).The operation time,completion time of nerve block,duration of subarachnoid anaesthesia and incidence of hypoxemia were recorded.Results There was no significant difference in VAS scores at T 0 among the three groups(all P>0.05).Compared with T 0,VAS scores at T 1 and T 3 were significantly decreased in group V(both P<0.05),while VAS score at T 2 was significantly increased(P<0.05).Compared with T 0,VAS scores from T 1 to T 3 were significantly decreased in group F and group C(all P<0.05).VAS scores in group F and group C were significantly lower than those in group V at T 1 and T 2(both P<0.05).The VAS score in group C was significantly lower than that in group F at T 2(P<0.05).There was no statistical difference in the time of Fascia iliaca compartment block between group F and group C(P>0.05),but the time for blocking perfection of group C was significantly shorter than that in group F(P<0.05).No significant difference was found in the subarachnoid block time among the three groups(all P>0.05).The incidence of respiratory depression in group V was significa

关 键 词：髂筋膜间隙阻滞 体位 髋骨折 

分 类 号：R614[医药卫生—麻醉学]