B超引导下腰丛坐骨神经阻滞结合髂筋膜置管持续镇痛在老年髋关节置换术中的应用价值  

Application Value of B-ultrasound-guided Lumbar Plexus Sciatic Nerve Block Combined with Iliac Fascia Cannula for Continuous Analgesia in Elderly Hip Arthroplasty

作　　者：熊英 XIONG Ying(First People’s Hospital of Jingdezhen,Jiangxi Province,Jingdezhen 333000,China)

机构地区：[1]江西省景德镇市第一人民医院,江西景德镇333000

出　　处：《中国医学创新》2022年第29期144-148,共5页Medical Innovation of China

基　　金：江西省卫生健康委科技计划项目(202140418)。

摘　　要：目的:探讨老年髋关节置换术中B超引导下腰丛坐骨神经阻滞结合髂筋膜置管持续镇痛的价值。方法:回顾性分析2018年2月-2020年2月景德镇市第一人民医院麻醉科60例老年髋关节置换术患者的临床资料,依据麻醉与镇痛方法分为B超引导下腰丛坐骨神经阻滞结合髂筋膜置管持续镇痛组(持续镇痛组)、气管插管全身麻醉结合经静脉自控镇痛组(自控镇痛组),各30例,统计分析两组麻醉效果、镇痛效果、生命体征、应激反应、不良反应发生情况。结果:持续镇痛组患者的麻醉优良率为96.67%(29/30),高于自控镇痛组76.67%(23/30)(χ^(2)=5.192,P<0.05)。术后2 h、12 h、1 d、2 d,持续镇痛组患者的视觉模拟评分法(VAS)评分均低于自控镇痛组(P<0.05)。T_(1)、T_(2)、T_(3)、T_(4),持续镇痛组患者的舒张压(DBP)、收缩压(SBP)、心率(HR)均高于自控镇痛组(P<0.05)。T_(1)、T_(2)、T_(3)、T_(4),持续镇痛组患者的皮质醇(Cor)、白介素-6(IL-6)、血糖水平均低于自控镇痛组(P<0.05)。持续镇痛组患者的不良反应发生率为6.67%(2/30),低于自控镇痛组的30.00%(9/30)(χ^(2)5.455,P<0.05)。结论:老年髋关节置换术中B超引导下腰丛坐骨神经阻滞结合髂筋膜置管持续镇痛的价值较气管插管全身麻醉结合经静脉自控镇痛高。Objective:To investigate the value of B ultrasound guided sciatic nerve block combined with iliac fascia catheter for continuous analgesia in elderly hip replacement.Method:The clinical data of 60 elderly patients who underwent hip replacement in Department of Anesthesiology,First People’s Hospital of Jingdezhen from February 2018 to February 2020 were retrospectively analyzed,according to the anesthesia and analgesia methods,the patients were divided into B ultrasound guided sciatic nerve block combined with fascia iliac continuous analgesia group(continuous analgesia group)and endotracheal intubation general anesthesia combined with controlled intravenous analgesia group(self-control analgesia group),30 cases in each group.The anesthetic effect,analgesic effect,vital signs,stress reaction and adverse reactions of the two groups were statistically analyzed.Result:The excellent and good anesthesia rate of patients in continuous analgesia group was 96.67%(29/30),which was higher than 76.67%(23/30)in self-control analgesia group(χ^(2)=5.192,P<0.05).At 2 h,12 h,1 d,and 2 d after operation,the visual analogue scale(VAS)scores of patients in the continuous analgesia group were lower than those in the self-control analgesia group(P<0.05).The diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR)of patients in the continuous analgesia group were higher than those in the self-control analgesia group(P<0.05).The levels of cortisol(Cor),interleukin-6(IL-6)and blood glucose of patients in the continuous analgesia group at T_(1),T_(2),T_(3) and T_(4) were lower than those in the self-control analgesia group(P<0.05).The incidence of adverse reactions in the continuous analgesia group was 6.67%(2/30),which was lower than 30.00%(9/30)in the self-control analgesia group(χ^(2)5.455,P<0.05).Conclusion:The value of B ultrasound guided low back plexus sciatic nerve block combined with fascia iliac catheterization for continuous analgesia in elderly hip arthroplasty is higher than that of endotracheal intuba

关 键 词：老年 髋关节置换术 B超 腰丛坐骨神经阻滞 髂筋膜置管 持续镇痛 气管插管全 身麻醉 经静脉自控镇痛 

分 类 号：R614[医药卫生—麻醉学]