髂筋膜间隙阻滞在老年髋部骨折术后镇痛的应用效果观察  

Application effect of iliac fascial space block in postoperative analgesia of elderly patients with hip fracture

作　　者：温锋 李继锋 WEN Feng;LI Ji-feng(Department of Anesthesiology,Jun County People′s Hospital,Hebi 456250,Henan,China;Department of Anesthesiology,Hebi People′s Hospital)

机构地区：[1]浚县人民医院麻醉科,河南鹤壁456250 [2]鹤壁市人民医院麻醉科

出　　处：《青岛医药卫生》2023年第1期9-12,共4页Qingdao Medical Journal

摘　　要：目的探讨老年髋部骨折术后髂筋膜间隙阻滞的镇痛效果。方法选择本院2020年2月至2021年10月手术治疗的老年髋部骨折患者123例,随机分为对照组61例和观察组62例,对照组给予术后舒芬太尼自控静脉镇痛,观察组给予联合髂筋膜间隙阻滞镇痛。比较两组术后镇痛效果、应激反应情况、疼痛介质水平及不良反应情况。结果观察组术后12h及24h疼痛评分低于对照组,术后舒芬太尼累计用量及按压次数较对照组少(P<0.05),术后48h疼痛评分两组差异无统计学意义(P>0.05);两组术后24h血管紧张素Ⅱ及皮质醇水平均较术前升高,且观察组低于对照组(P<0.05);两组术后24h P物质(SP)、5羟色胺(5-HT)、神经肽Y(NPY)及前列腺素E_(2)(PGE_(2))水平均较手术结束时升高,且观察组低于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论术后舒芬太尼静脉自控镇痛联合髂筋膜间隙阻滞镇痛可有效降低疼痛介质分泌水平,减轻应激反应程度,缓解术后疼痛,进而减少术后自控泵舒芬太尼用量及按压次数,且不增加不良反应发生风险。Objective To explore the analgesic effect of iliac fascial space block after hip fracture in the elderly.Methods A total of 123 elderly patients with hip fracture who underwent surgical treatment from February 2020 to October 2021 were enrolled and randomly divided into the control group(n=61)and the observation group(n=62).The control group received postoperative sufentanil controlled intravenous analgesia,and the observation group received combined iliac fascia space block analgesia.Postoperative analgesic effect,stress response,pain media level and adverse reactions were compared between the two groups.Results The pain score of the observation group was lower than that of the control group at 12h and 24h after surgery,and the cumulative amount of sufentanil and pressing times were less than those of the control group(P<0.05).There was no significant difference in the pain score at 48h after surgery between the two groups(P>0.05).The levels of angiotensinⅡand cortisol in the two groups at 24h after operation were higher than those before operation,and the levels in the observation group were lower than those in the control group(P<0.05);the levels of SP,5-HT,NPY and PGE_(2)in the two groups at 24h after operation were higher than those at the end of operation,and the levels in the observation group were lower than those in the control group(P<0.05);there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Postoperative sufentanil controlled intravenous analgesia combined iliac fascia space block analgesia can effectively reduce the level of pain medium secretion,reduce the degree of stress reaction,relieve postoperative pain,and further reduce the dosage of sufentanil and the number of press,without increasing the risk of adverse reactions.

关 键 词：髂筋膜间隙阻滞 自控静脉镇痛 应激反应 疼痛介质 

分 类 号：R683.42[医药卫生—骨科学]