凸阵探头辅助髂筋膜间隙阻滞在髋关节置换术围术期镇痛的应用  

Effectiveness of Fascia Iliaca Compartment Block with Convex Array Transducer for Perioperative Analgesia Undergoing Hip Orthroplasty

作　　者：林汉城[1] 周毅娟 LIN Hancheng;ZHOU Yijuan(Department of Anesthesiology,the First Affiliated Hospital of Xiamen University,Xiamen City,Fujian Province 361022;不详)

机构地区：[1]厦门大学附属第一医院麻醉科,福建省厦门市361022 [2]厦门市海沧医院麻醉科

出　　处：《医学理论与实践》2022年第13期2180-2183,共4页The Journal of Medical Theory and Practice

摘　　要：目的:探讨凸阵探头超声引导下髂筋膜间隙阻滞在围术期老年髋关节置换术中的镇痛疗效。方法:60例择期行单侧髋关节置换术的老年患者被随机分为:静脉注射芬太尼组(IVFE组)和髂筋膜间隙阻滞组(FICB组),各30例。IVFE组注射芬太尼后行腰麻;FICB组则先行髂筋膜间隙阻滞(0.25%罗哌卡因30ml)。记录术前和术后参数,如VAS评分、腰麻定位质量和操作时长、血压和心率、术后PCIA按压次数及追加镇痛药的例数、麻醉满意度及并发症发生率。结果:两组干预后VAS评分均显著降低,而IVFE组在腰麻定位时再次显著升高(P<0.05)。与IVFE组相比,FICB组在术后4h、8h、12h的VAS评分均有显著降低(P<0.05)。腰麻定位时血流动力学IVFE组显著升高,而FICB组则明显降低,两组术毕时均显著降低(P<0.05)。FICB组术后4h、8h、12h及24h的PCIA按压次数显著较IVFE组少(P<0.001)。FICB组腰麻的定位质量、操作时长和麻醉满意度均显著优于IVFE组(P<0.05)。术后首次下床活动时间明显短于IVFE组(P=0.001)。IVFE组不良反应总发生率和追加镇痛药的例数显著高于FICB组(P<0.05)。结论:超声引导下髂筋膜间隙阻滞可有效缓解髋关节置换术围术期的疼痛,改善患者体位质量,缩短腰麻时间,对患者血流动力学影响小,且并发症很少。Objective:To investigate the effect of fascia iliaca compartment block with convex array transducer for perioperative analgesia in gerontal patients undergoing hip orthroplasty.Methods:60 gerontal patients scheduled for who were underwent elective unilateral hip orthroplasty were randomly divided into two groups:intravenous fentanyl group(IVFE group)and fascia iliaca compartment block(FICB group),30 patients each.Before positioning for spinal anesthesia,IVFE group were injected with fentanyl and FICB group were received FICB with 30ml of 0.25%ropivacaine.Pain intensity in visual analogue scale(VAS),quality of positioning and time to perform for spinal anesthesia,blood pressure and heart rate for perioperative,the times of PCIA pressing and the number of cases requiring additional analgesia within 48 hours after surgery,incidence of adverse reactions in anaesthesia and patient acceptance were assessed.Results:After intervention,the VAS scores of two groups were significantly decreased compared with those before intervention,but during spinal anesthesia positioning,VAS in IVFE group was significantly increased than that after intervention(P<0.05).At 4,8,12 hours after surgery,VAS in FICB group were significantly lower than those in IVFE group(P<0.05).Hemodynamics increased significantly in IVFE group and decreased significantly in FICB group during spinal anesthesia positioning,and decreased significantly after operation(P<0.05).The times of PCIA successfully pressing in FICB group was significantly lower at 4,8,12,24 hours and h after surgery than those in IVFE group(P<0.001).The quality of positioning,time to perform for spinal anesthesia and spinal anesthesia satisfaction were significantly better in FICB group than those in IVFE group(P<0.05).The time of first ambulation after operation was significantly shorter in FICB group than IVFE group(P=0.001).Compared with FICB group,the incidence of adverse reactions in anaesthesia and the number of cases requiring additional analgesia were significantly increased in I

关 键 词：髋部骨折 髂筋膜间隙阻滞 腰麻定位 髋关节置换术 凸阵探头 

分 类 号：R614[医药卫生—麻醉学]