老年全髋关节置换术高位髂筋膜阻滞的意义  

Significance of high fascia iliaca compartment block following total hip arthroplasty in elderly

作　　者：鹿洪秀[1] 张金 杨沛然 孙莉 张建新[1] LU Hong-xiu;ZHANG Jin;YANG Pei-ran;SUN Li;ZHANG Jian-xin(Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Ji'nan 250011,China)

机构地区：[1]山东中医药大学附属医院,山东济南250011

出　　处：《中国矫形外科杂志》2023年第11期1035-1038,共4页Orthopedic Journal of China

基　　金：山东省医药卫生科技发展计划项目(编号:202104070458)。

摘　　要：[目的]探讨高位髂筋膜阻滞(fascia iliaca compartment block,FICB)在老年全髋关节置换术(total hip arthroplasty,THA)的意义。[方法]140例老年初次单侧THA患者随机分为两组,70例采用高位FICB联合舒芬太尼患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)(复合组),另外70例采用单纯PCIA(PCIA)组。比较两组术后镇痛和临床资料。[结果]复合组术后8、12、24 h的VAS评分[(2.3±0.4)vs(2.6±0.7),P=0.002;(2.7±0.5)vs(3.4±0.7),P<0.001;(3.0±0.7)vs(3.4±0.6),P<0.001]和BCS评分[(3.3±0.5)vs(2.4±0.4),P<0.001;(2.5±0.4)vs(1.9±0.5),P<0.001;(2.9±0.6)vs(2.1±0.6),P<0.001]均显著优于PCIA组。复合组48 h PCIA总按压次数[(5.2±2.2)次vs(9.8±1.4)次,P<0.001]和镇痛补救率[5(7.1%)vs 18(25.7%),P=0.003]均显著优于PCIA组。复合组术后第1 d和3 d的MMSE评分[(8.7±2.1)vs(11.2±1.9),P<0.001;(7.7±1.7)vs(8.7±1.8),P=0.001]和PSQI评分[(8.7±2.1)vs(11.2±1.9),P<0.001;(7.7±1.7)vs(8.7±1.8),P=0.001]均显著优于PCIA组。出院时复合组的Harris评分[(80.6±5.6)vs(77.4±5.4),P=0.001]显著优于PCIA组。复合组术后5 d头晕、恶心呕吐、便秘的发生率[(2.9%)vs(12.9%),P=0.028;(4.3%)vs(18.6%),P=0.017;(8.6)%vs(25.7%),P=0.015]显著低于PCIA组。[结论]高位FICB联合PCIA可有效减轻THA的疼痛,提高术后的舒适度,降低术后谵妄和其他并发症的发生率,改善睡眠质量,促进髋关节功能的快速恢复。[Objective]To explore the significance of fascia iliaca compartment block(FICB)after total hip arthroplasty(THA)in the el-derly.[Methods]A total of140 elderly patients who underwent primary unilateral THA were randomly divided into 2 groups.Of them,70 pa-tients were treated with high FICB combined with patient-controlled intravenous analgesia(PCIA)(the compound group),while the other 70 patients were treated with PCIA only(the PCIA group).Postoperative analgesia and clinical data were compared between the two groups.[Results]The compound group proved significantly superior to the PCIA group in terms of VAS score[(2.3±0.4)us(2.6+0.7),P=0.002;(2.7±0.5)us(3.4±0.7),P<0.001;(3.0±0.7)us(3.4±0.6),P<0.001]and BCS scores[(3.3±0.5)vs(2.4±0.4),P<0.001;(2.5±0.4)us(1.9±0.5),P<0.001;(2.9+0.6)us(2.1±0.6),P<0.001]8,12 and 24 hours postoperatively.In addition,the former was also significantly superior to the latter regard-ing to the total number of PCIA compressions within 48 hours[(5.2±2.2)times us(9.8±1.4)times,P<0.001]and additional analgesic usage rate[5(7.1%)us 18(25.7%),P=0.003].Furthermore,the compound group was significantly superior to the PCIA group in terms of MMSE scores[(8.7±2.1)us(11.2±1.9),P<0.001;(7.7±1.7)us(8.7±1.8),P=0.001]and PSQI score[(8.7±2.1)us(11.2±1.9),P<0.001;(7.7±1.7)us(8.7±1.8),P=0.001]1 and 3 days after surgery.Moreover,the compound group got significant higher Harris score at discharge(P<0.05),with significantly lower complication rate,such as dizziness,nausea,vomiting and constipation within 5 days after operation than the PCIA group(P<0.05).[Conclusion]High FICB combined with PCIA does effectively alleviate pain,improve postoperative comfort,reduce the in-cidence of postoperative delirium and other complications,improve sleep quality,enhance the rapid recovery of hip function after THA in the elderly.

关 键 词：全髋关节置换 患者自控静脉镇痛 髂筋膜阻滞 术后谵妄 

分 类 号：R687.4[医药卫生—骨科学]