超声引导下连续髂筋膜阻滞联合单次腰麻在老年人髋关节置换中的应用  

Application of ultrasound-guided continuous fascia block combined with single spinal anesthesia in hip replacement in the elderly

作　　者：林海荣 邱晨 张俊峰 LIN Hai-rong;QIU Chen;ZHANG Jun-feng(Shenzhen Fuyong People's Hospital,Shenzhen,Guangdong 518100)

机构地区：[1]深圳市宝安区福永人民医院,广东深圳518100

出　　处：《赣南医学院学报》2023年第4期376-380,共5页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨超声引导下髂筋膜阻滞联合单次单侧腰麻在老年人髋关节置换手术中的应用效果。方法:选取2020年3月—2021年3月择期行髋关节置换手术患者85例,随机分为A(n=28)、B(n=29)、C(n=28)三组,分别给予腰硬联合、单次单侧腰麻及超声引导髂筋膜阻滞联合单次单侧腰麻。记录感觉、运动阻滞维持时间、Bromage运动阻滞评分,记录麻醉前5 min(T_(1))、麻醉后5 min(T_(2))、10 min(T_(3))、15 min(T_(4))、20 min(T_(5))、25 min(T_(6))、30 min(T_(7))各个时间点患者一般情况、血压、心率、麻黄碱使用例数、术后首次按压镇痛泵的时间、术后24 h和48 h按压镇痛泵的次数、补救镇痛泵次数以及术后头痛、恶心、呕吐并发症的发生情况。结果:三组患者的感觉、触觉、温觉阻滞平面、起效时间及消退时间比较差异无统计学意义(P>0.05);B、C两组在麻醉后10 min(T_(3))SBP、DBP高于A组,差异有统计学意义(P<0.05);B、C两组使用麻黄碱的例数少于A组,差异有统计学意义(P<0.05);C组术后首次按压镇痛泵的时间晚于A、B两组,差异有统计学意义(P<0.05);C组术后24 h和48 h按压镇痛泵的次数、补救镇痛泵次数均少于A、B两组,差异有统计学意义(P<0.05);A、B、C三组术后头痛、恶心、呕吐并发症发生率比较差异无统计学意义(P>0.05)。结论:超声引导下髂筋膜阻滞联合单次单侧腰麻,可减少麻黄碱的使用,降低术后VAS评分,延长手术及术后镇痛时间,为老年髋关节置换手术提供良好的麻醉效果。Objective:To investigate the effect of ultrasound-guided iliac fascia block combined with single unilateral lumbar anesthesia in hip arthroplasty in the elderly.Methods:A total of 85 cases scheduled for hip replacement surgery from March 2020 to March 2021 were included,and they were randomly divided into Group A(n=28),Group B(n=29)and Group C(n=28)Spinal-epidural conjunctions,single unilateral lumbar anesthesia and ultrasound-guided iliac fascia block combined with single unilateral lumbar anesthesia were given respectively.Sensation,retention time of motion block and Bromage motion block score were recorded;5min before anesthesia(T_(1)),5min after anesthesia(T_(2)),10 min(T_(3)),15 min(T_(4)),20 min(T_(5)),25 min(T_(6)),and 30 min(T_(7))were recorded;at various time points,patients'general conditions,blood pressure,heart rate,ephedrine use cases,the time of first pressing the analgesic pump after surgery,the number of pressing the analgesic pump 24 h and 48 h after surgery,the number of remedyingthe analgesic pump,and the incidence of postoperative complications of headache and vomitingwere recorded.Results:There were no significant differences in sensation,tactile sensation,temperature block level,onset time and subsidence time among the three groups(P>0.05).10 min after anesthesia(T_(3)),SBP,DBP of Group B and C were higher than those of Group A,with statistical significance(P<0.05).The number of ephedrine cases in Group B and C was less than that in Group A,with statistical significance(P<0.05).The first time of pressing the analgesia pump in Group C was longer than that in Group A and Group B,withstatistical significance(P<0.05).The number of pressing the analgesia pump and the number of remedial analgesia pump in Group C in 24 h and 48 h after surgery were less than those in Group A and Group B,with statistical significance(P<0.05).The incidence of postoperative headache and nausea in Group A,B and C was not statistically significant(P>0.05).Conclusion:Under acoustic guidance,iliac fascia block combined wi

关 键 词：超声引导髂筋膜阻滞 髋关节置换 单次单侧腰麻阻滞 腰硬联合阻滞 

分 类 号：R614.4[医药卫生—麻醉学]