腰方肌阻滞与髂筋膜阻滞用于全髋关节置换术后镇痛效果的Meta分析  

Meta-analysis of Analgesic Effect of Quadratus Lumborum Block and Fascia Iliac Block After Total Hip Arthroplasty

作　　者：何治江 赵玲[2] 张朝贵[2] 刘飞宇 HE Zhi-jiang;ZHAO Ling;ZHANG Chao-gui;LIU Fei-yu(Department of Anesthesiology,North Sichuan Medical College,Nanchong 637000,Sichuang,China;Department of Anesthesiology,the Second People's Hospital of Yibin,Yibin 644000,Sichuang,China)

机构地区：[1]川北医学院麻醉学系,四川南充637000 [2]宜宾市第二人民医院麻醉科,四川宜宾644000

出　　处：《医学信息》2023年第12期13-19,共7页Journal of Medical Information

基　　金：四川省宜宾市卫健委课题(编号:2020yw033)。

摘　　要：目的比较腰方肌阻滞(QLB)与髂筋膜阻滞(FIB)用于全髋关节置换术(THA)后的镇痛效果。方法检索PubMed、Medicine、Cochrane Library、中国知网、万方、维普数据库,收集比较QLB与FIB用于THA术后镇痛效果的随机对照试验(RCT),主要结局指标为术后不同时间静息与活动VAS评分,次要指标为术后24 h阿片药物用量与股四头肌肌力,采用RevMan5.3软件进行Meta分析。结果共纳入7项RCTs,共511例患者,其中QLB组255例,FIB组256例;Meta分析显示:QLB组与FIB组在术后2、6、8、12、24 h静息状态与术后6 h活动状态下镇痛效果相当,差异无统计学意义(P>0.05);QLB组在术后12 h(MD=-1.54,95%CI:-2.88~-0.20,P=0.02)与24 h(MD=-1.13,95%CI:-2.17~-0.08,P=0.04)活动状态下镇痛效果优于FIB组,差异有统计学意义(P<0.05);QLB组术后24 h阿片药物用量少于FIB组(SMD=-1.39,95%CI:-2.52~-0.26,P=0.02),差异有统计学意义(P<0.05);QLB组术后6 h内股四头肌肌力更高。结论QLB镇痛效果不弱于FIB,且缓解活动疼痛效果更佳,术后阿片药物用量更少,对股四头肌肌力影响更小。Objective To compare the analgesic effect of quadratus lumborum block(QLB)and fascia iliac block(FIB)after total hip arthroplasty(THA).Methods PubMed,Medicine,Cochrane Library,CNKI,Wanfang,and VIP databases were searched to collect randomized controlled trials(RCTs)comparing the analgesic effects of QLB and FIB after THA.The main outcome indicators were resting and active VAS scores at different times after surgery.The secondary indicators were opioid dosage and quadriceps muscle strength at 24 h after surgery.Meta-analysis was performed using RevMan 5.3 software.Results A total of 7 RCTs involving 511 patients were included,while 255 patients in the QLB group and 256 patients in the FIB group.Meta-analysis showed that the analgesic effect of QLB group and FIB group at 2,6,8,12,24 h after operation was similar to that at 6 h after operation(P>0.05);the analgesic effect of QLB group was better than that of FIB group at 12 h(MD=-1.54,95%CI:-2.88 to-0.20,P=0.02)and 24 h(MD=-1.13,95%CI:-2.17 to-0.08,P=0.04)after operation,and the difference was statistically significant(P<0.05);the dosage of opioids in QLB group was less than that in FIB group at 24 h after operation(SMD=-1.39,95%CI:-2.52 to-0.26,P-0.02),and the difference was statistically significant(P<0.05).The quadriceps muscle strength was higher in the QLB group within 6 hours after operation.Conclusion The analgesic effect of QLB is not weaker than that of FIB,and the effect of relieving active pain is better,the dosage of opioids after operation is less,the effect on quadriceps muscle strength is less.

关 键 词：全髋关节置换术 腰方肌阻滞 髂筋膜阻滞 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]