超声引导下股神经阻滞复合自控静脉镇痛和硬膜外镇痛对骨科术后患者夜间睡眠质量的影响分析  

Effect of ultrasound-guided femoral nerve block combined with patient-controlled intravenous analgesia and epidural analgesia on nighttime sleep quality in patients after orthopedic surgery

作　　者：李松泽 鞠浩[2] 朱天彤 史婧文 黄泽清 LI Song-ze;JU Hao;ZHU Tian-tong;SHI Jing-wen;HUANG Ze-qing(Department of Anesthesiology,Cancer Hospital of China Medical University,Liaoning Cancer Hospital&Institute,Shenyang 110042,China;Department of Ultrasound,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学肿瘤医院辽宁省肿瘤医院麻醉科,辽宁沈阳110042 [2]中国医科大学附属盛京医院超声科,辽宁沈阳110004

出　　处：《中国临床医学影像杂志》2021年第8期547-551,共5页Journal of China Clinic Medical Imaging

基　　金：辽宁省自然科学基金指导计划项目(编号20180550218)。

摘　　要：目的:研究超声引导下股神经阻滞(USFNB)复合自控静脉镇痛(Patient-controlled intravenous analgesia,PCIA)和硬膜外镇痛(Patient-controlled epidural analgesia,PCEA)对骨科术后患者夜间睡眠质量的影响。方法:选择2018年9月—2020年9月在中国医科大学肿瘤医院辽宁省肿瘤医院骨与软组织外科进行全麻下下肢骨科手术的患者85例。将患者分为PCEA组与USFNB+PCIA组,其中PCEA组42例,USFNB+PCIA组43例。术后PCEA组留硬膜外导管进行PCEA,USFNB+PCIA组在超声引导下行股神经阻滞后,连接静脉镇痛泵。检测患者术后视觉模拟疼痛评分(VAS)情况、睡眠质量和炎症因子水平。结果:两组患者术后12~72 h VAS评分逐步降低,两组患者术后12 h VAS评分比较无统计学意义(P>0.05),术后24 h、48 h、72 h,USFNB+PCIA组患者VAS评分低于PCEA组,且差异有显著统计学意义(P<0.01)。两组患者术后24~72 h匹兹堡睡眠质量指数量表(PSQI)评分>7分的患者人数逐渐降低,且任何时间点USFNB+PCIA组PSQI评分>7分的患者人数明显低于PCEA组,差异有显著统计学意义(P<0.01)。两组患者术后24~72 h超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度随时间延长而降低,且任何时间点USFNB+PCIA组hs-CRP、IL-6明显低于PCEA组,差异有显著统计学意义(P<0.01)。结论:USFNB+PCIA能有效提高下肢骨科手术患者的术后睡眠质量,并降低炎症因子水平,可能是改善下肢骨科手术患者预后的有效措施。Objective:To study the effects of ultrasound-guided femoral nerve block(USFNB)combined with patient-controlled intravenous analgesia(PCIA)and epidural analgesia(PCEA)on the quality of sleep in patients after orthopedic surgery.Methods:From September 2018 to September 2020,85 patients with general anesthesia and lower extremity orthopedic surgery were selected from the Cancer Hospital of China Medical University,Liaoning Cancer Hospital&Institute.Patients were divided into PCEA group(n=42)and USFNB+PCIA group(n=43).The PCEA group retained epidural catheter for PCEA.The USFNB+PCIA group was connected with intravenous analgesia pump.Postoperative visual analog scale(VAS),sleep quality and inflammatory factors were detected.Results:The VAS scores of the two groups were gradually decreased from 12 h to 72 h after operation.The VAS scores of the two groups were not statistically significant(P>0.05).The VAS scores of the USFNB+PCIA group were lower than those of the PCEA group at 24 h,48 h,and 72 h after operation,and the difference was highly statistically significant(P<0.01).The number of patients with PSQI score>7 points decreased from 24 h to 72 h after operation in 2 groups,and the number of patients with PSQI score>7 at any time point in USFNB+PCIA group was significantly lower than that in PCEA group,the difference was highly statistically significant(P<0.01).The hs-CRP,IL-6,and TNF-αconcentrations in the two groups decreased from 24 h to 72 h after surgery,and the hs-CRP,IL-6 at any time point in USFNB+PCIA group were significantly lower than those in PCEA group,and the difference was highly statistically significant(P<0.01).Conclusion:USFNB+PCIA can effectively improve the postoperative sleep quality and reduce the level of inflammatory factors in patients with lower extremity orthopedic surgery,which may be an effective measure to improve the prognosis of patients.

关 键 词：骨疾病 镇痛 睡眠 超声检查 介入性 

分 类 号：R681.8[医药卫生—骨科学] R445.1[医药卫生—外科学]