UIFB联合羟考酮PCIA在髋部骨折手术加速康复中的效果评价  

Evaluation of ultrasound-guided iliaca fascia block combined with patient-controlled intravenous analgesia using oxycodone in accelerating rehabilitation after hip orthopedic surgery

作　　者：华豪 刘祯庆 张斌 孙大鹏[3] 张邓新 Hua Hao;Liu Zhenqing;Zhang Bin;Sun Dapeng;Zhang Dengxin(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,Wuxi No.9 People's Hospital Affiliated to Soochow University,Wuxi 214062,China;Department of Anesthesiology,the Affiliated Hospital of Jiangnan University,Wuxi 214122,China;Department of Anesthesiology,the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University,Wuxi 214002,China)

机构地区：[1]徐州医科大学麻醉学院,徐州221004 [2]苏州大学附属无锡市第九人民医院麻醉科,无锡214062 [3]江南大学附属医院麻醉科,无锡214122 [4]南京医科大学附属无锡妇幼保健院麻醉科,无锡214002

出　　处：《国际麻醉学与复苏杂志》2022年第1期58-62,共5页International Journal of Anesthesiology and Resuscitation

基　　金：江苏省无锡市科技局面上项目(WX18IIAN014);江苏省无锡市卫健委科技成果与适宜技术推广项目(T201908)。

摘　　要：目的评价超声引导下髂筋膜阻滞(ultrasound-guided iliac fascia block,UIFB)联合羟考酮患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)在髋部骨折患者术后康复中的效果。方法选取蛛网膜下腔阻滞麻醉下行髋部骨折内固定术的患者75例,按随机数字表法分为PCIA组(Ⅰ组)、UIFB组(Ⅱ组)、UIFB联合PCIA组(Ⅲ组),每组25例。Ⅰ组患者常规施行蛛网膜下腔阻滞,Ⅱ组、Ⅲ组患者在蛛网膜下腔阻滞前先行患侧UIFB;术后Ⅰ组、Ⅲ组患者连接PCIA泵,配方均为羟考酮50 mg+托烷司琼6 mg+生理盐水稀释至100 ml,自控镇痛单次剂量4 ml,锁定时间5 min。记录3组患者术后6、12、24、36、48 h VAS疼痛评分,术后24、48 h患侧髋关节的外展度和屈曲度,术后48 h恶心呕吐、皮肤瘙痒、嗜睡、呼吸抑制等不良反应发生情况,记录3组患者对镇痛效果满意的比例及住院天数,记录Ⅰ组和Ⅲ组患者术后48 h羟考酮总用量及PCIA有效按压次数。结果术后6、12、24、36 hⅡ组、Ⅲ组患者VAS疼痛评分低于Ⅰ组(P<0.05),Ⅲ组患者VAS疼痛评分低于Ⅱ组(P<0.05);Ⅱ组、Ⅲ组患者住院天数少于Ⅰ组(P<0.05),Ⅲ组患者住院天数少于Ⅱ组(P<0.05);Ⅲ组患者术后48 h羟考酮总用量低于Ⅰ组,术后48 h PCIA有效按压次数少于Ⅰ组(P<0.05);术后24、48 hⅡ组、Ⅲ组患者患侧髋关节屈曲度、外展度大于Ⅰ组(P<0.05),Ⅲ组患者患侧髋关节屈曲度、外展度大于Ⅱ组(P<0.05);Ⅱ组、Ⅲ组患者恶心呕吐、嗜睡发生率低于Ⅰ组(P<0.05),Ⅲ组患者恶心呕吐发生率低于Ⅱ组(P<0.05)。Ⅱ组、Ⅲ组对镇痛效果满意的患者比例高于Ⅰ组(P<0.05),Ⅲ组对镇痛效果满意的患者比例高于Ⅱ组(P<0.05)。结论与传统的PCIA方式或单纯UIFB相比,UIFB联合羟考酮PCIA在骨科髋部手术后镇痛效果确切,增加患者患侧髋关节最大外展度和屈曲度,减少阿片类镇痛药的相关不良反应,可加速患者术后康复。Objective To evaluate the effect of ultrasound-guided iliaca fascia block(UIFB)combined with patient-controlled intravenous analgesia(PCIA)using oxycodone on the postoperative rehabilitation in patients undergoing hip orthopedic surgery.Methods A total of 75 patients who underwent hip orthopedic surgery under spinal anesthesia were enrolled.According to the random number table method,they were divided into three groups(n=25):a PCIA group(group Ⅰ),a UIFB group(group Ⅱ),and a UIFB+PCIA group(group Ⅲ).Spinal anesthesia was routinely performed in groupⅠ,while UIFB was performed on the affected side in group Ⅱ and group Ⅲ before spinal anesthesia.After surgery,patients in groups Ⅰ and Ⅱ were connected with PCIA pumps which contained 50 mg oxycodone and 6 mg tropisetron in 100 ml normal saline and were programmed to deliver 4 ml each time with a terval of 5 min.The Visual Analog Scale(VAS)scores 6,12,24,36 h and 48 h after surgery,the flexion and abduction of the affected hip joint 24 h and 48 h after surgery,and the incidences of adverse reactions,such as nausea and vomiting,itchy skin,drowsiness and respiratory suppression,etc.48 h after surgery were recorded.The percentage of overall satisfaction and the length of hospitalization stay were recorded.The total doses of oxycodone 48 h after surgery and the effective pressing number of PCIA pump were recorded in group Ⅰ and group Ⅲ.Results In the current study,6,12,24 h and 36 h after surgery,patients in group Ⅱ and group Ⅲ presented lower VAS scores than group Ⅰ(P<0.05),and group Ⅲ presented lower VAS scores than group Ⅱ(P<0.05);patients in group Ⅱ and group Ⅲ showed shorter length of hospitalization stay than group I(P<0.05),and group Ⅲ presented shorter length of hospitalization stay than group Ⅱ(P<0.05).Patients in group Ⅲ showed less oxycodone consumption,and a less effective pressing number of PCIA pump than group Ⅰ 48 h after surgery(P<0.05).Patients in group Ⅱ and group Ⅲ showed larger flexion and abduction of the af

关 键 词：髂筋膜阻滞 羟考酮 患者自控静脉镇痛 

分 类 号：R614[医药卫生—麻醉学]