术前超声引导髂筋膜间隙阻滞持续镇痛在老年髋部骨折患者中的应用  

Application of preoperative ultrasound-guided fascia iliaca compartment block for continuous analgesia in elderly patients with hip fracture

作　　者：涂文劭[1] 郑艇[1] 陈江湖[1] 高飞[1] 郑晓春[1] TU Wenshao;ZHENG Ting;CHEN Jianghu;GAO Fei;ZHENG Xiaochun(Department of Anaesthesiology,Provincial Clinical Medical College of Fujian Medical University,Fujian Provincial Hos­pital's Fuzhou,Fujian 350001,China)

机构地区：[1]福建医科大学省立临床医学院麻醉科福建省立医院麻醉科,福州350001

出　　处：《福建医药杂志》2021年第3期4-6,共3页Fujian Medical Journal

基　　金：福建省医学创新课题(2018-CX-2)。

摘　　要：目的探讨术前超声引导髂筋膜间隙阻滞持续镇痛在老年髋部骨折患者中应用的可行性和有效性。方法选择我院收治的老年髋部骨折患者60例,随机分为观察组和对照组,各30例。观察组入院后排除神经阻滞相关禁忌证,即刻在超声引导下行髂筋膜间隙阻滞持续镇痛直至术前;对照组根据患者镇痛需要间断给予缓慢静脉注射氟比洛芬酯注射液直至术前。比较两组入院时、入院后第1天、第2天、术前1天平均动脉压(MAP)、心率(HR),术前1天行双下肢静脉彩超检查观察双下肢血栓发生情况,同时抽取外周静脉血测定去甲肾上腺素、肾上腺素含量,并进行患者满意度评分等。结果与对照组比较,观察组入院后第1天、第2天、术前1天MAP、HR均明显降低(P<0.05);术前1天静脉血中去甲肾上腺素、肾上腺素含量对比,对照组高于观察组(P<0.05);术前行双下肢静脉彩超检查发现,对照组下肢静脉血栓发生率高于观察组(P<0.05);患者满意度评分对比,对照组低于观察组(P<0.05)。结论术前超声引导髂筋膜间隙阻滞持续镇痛应用于老年髋部骨折患者,具有镇痛效果好、创伤应激小、下肢静脉血栓发生率低、患者满意度高等优点,该方法值得在临床上推广应用。Objective To investigate the feasibility and the efficiency of preoperative ultrasound-guided fascia iliaca compartment block for continuous analgesia in elderly patients with hip fracture.Methods A total of 60 elderly patients with hip fracture were selected as the research subjects in our hospital,and then were randomly divided into observation group(n=30)and control group(n=30).For the observation group:the contraindications related to nerve block were excluded after admission,and then underwent ultrasound-guided fascia iliaca compartment block for continuous analgesia immediately.For the control group:flurbiprofen was injected at intervals according to the needs of patientsanalgesia.The MAP and HR at admission,on the first day,the second day after admission and the day before surgery were compared between the two groups.The thrombosis of lower extremities was examined by color doppler ultrasonography.The norepinephrine,epinephrine contents in peripheral venous blood and satisfaction score of patients were measured on the day before surgery.Results Compared with the control group,the MAP and HR were significantly decreased in the observation group on the first day,the second day after admission and the day before surgery(both P<0.05).On the day before surgery,compared with the observation group,the contents of norepinephrine and epinephrine in the venous blood were significantly higher in the control group(both P<0.05).The incidence of venous thrombosis in the control group was significantly higher in the control group than that in the observation group(P<0.05).The satisfaction score of patients was significantly lower in the control group than that in the observation group(P<0.05).Conclusion The application of preoperative ultrasound-guided fascia iliaca compartment block for continuous analgesia can significantly relieve the pain,reduce the stress response caused by trauma,reduce the incidence of venous thrombosis in lower extremity and improve satisfaction in elderly patients with hip fracture.This metho

关 键 词：超声 髂筋膜间隙 老年 髋关节 镇痛 

分 类 号：R614[医药卫生—麻醉学]