腰丛阻滞和腹股沟上髂筋膜阻滞在老年髋关节置换术中的比较  

Comparison of lumbar plexus block and supra-inguinal fascia iliaca compartment block in elderly hip arthroplasty

作　　者：关山 吴川[1] 霍树平[1] 石娜[1] 刘飞飞[1] 李昭[1] 刘欣[1] 王秀丽[1] GUAN Shan;WU Chuan;HUO Shuping;SHI Na;LIU Feifei;LI Zhao;LIU Xin;WANG Xiuli(Department of Anesthesiology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院麻醉科,石家庄市050051

出　　处：《临床麻醉学杂志》2021年第7期684-688,共5页Journal of Clinical Anesthesiology

基　　金：河北省适宜卫生技术推广项目(P20190020)。

摘　　要：目的比较超声引导下腰丛阻滞(LPB)和腹股沟上髂筋膜阻滞(SIFICB)在老年髋关节置换术中的麻醉效果。方法选择2019年9月至2020年3月髋部骨折拟行单侧髋关节置换术的老年患者60例,男18例,女42例,年龄65~85岁,BMI 19~27 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法分为两组:超声引导下LPB联合全身麻醉组(L组)和超声引导下SIFIB联合全身麻醉组(S组),每组30例。两组于全身麻醉前行神经阻滞,阻滞起效后进行全身麻醉诱导,术中均采用喉罩通气,维持BIS 40~60,术后采用患者自控镇痛(PCA)。记录神经阻滞操作时间及起效时间,术中麻醉药物和血管活性药物使用情况。记录术前、术后4、12、24 h静息和咳嗽时VAS疼痛评分以及术后4、12、24 h舒芬太尼累计用量。分别于术前、术后4、24 h检测血清P物质浓度。记录恶心呕吐、呼吸抑制等不良反应的发生情况。结果与L组比较,S组神经阻滞操作时间明显缩短(P<0.05),闭孔神经阻滞起效时间明显延长(P<0.05)。两组术中麻醉药物和血管活性药物使用情况、VAS疼痛评分、术后舒芬太尼累计用量以及血清P物质浓度差异无统计学意义。两组不良反应发生率差异无统计学意义。结论与腰丛阻滞比较,超声引导下腹股沟上髂筋膜阻滞操作时间短,且具有与腰丛阻滞相近的镇痛效果。Objective To compare the anesthetic effects of ultrasound-guided lumbar plexus block(LPB)and supra-inguinal fascia iliaca compartment block(SIFICB)in elderly hip arthroplasty.Methods Sixty elderly patients undergoing the elective hip arthroplasty from September 2019 to Mary 2020,18 males and 42 females,aged 65-85 years,BMI 19-27 kg/m^(2),ASA physical status Ⅱ or Ⅲ,were randomly divided into 2 groups using random number table(n=30):ultrasound-guided LPB combined with general anesthesia(group L)and ultrasound-guided SIFICB combined with general anesthesia(group S).Nerve block was performed before general anesthesia,and general anesthesia was induced after the onset of block.During the operation,both groups were ventilated with a laryngeal mask to maintain a BIS value of 40-60,and patient-controlled intravenous analgesia(PCA)was given after the operation.The operation time and onset time of nerve block,intraoperative use of anesthetics and vasoactive drugs,visual analogue scale(VAS)score at rest and cough at preoperative,4,12 and 24 hours after surgery,accumulated dosage of sufentanil in PCA 4,12 and 24 hours after surgery,occurrence of adverse reactions such as nausea,vomiting and respiratory depression were recorded in both groups.Blood samples were taken at preoperative,4 and 24 hours after surgery to detect the concentration of substance P in serum.Results Compared with group L,the operation time of nerve block was significantly shorter and the onset time of obturator nerve block was prolonged in group S(P<0.05).There were no statistically significant differences between the two groups in intraoperative use of anesthetics and vasoactive drugs,postoperative VAS scores,the concentration of substance P in serum,accumulated dosage of sufentanil in PCA and adverse reactions.Conclusion Compared with LPB,ultrasound-guided SIFICB has shorter operation time and similar analgesia effect as lumbar plexus block.

关 键 词：超声 髂筋膜阻滞 老年 髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]