入院后即刻连续腰丛神经阻滞镇痛对老年髋关节置换病人加速康复外科的影响  

Effect of continuous lumbar plexus block analgesia immediately after admission on ERAS in elderly patients undergoing hip arthroplasty

作　　者：尚磊晶 张蜜 范冬冬 李苗 李元海[2] SHANG Leijing;ZHANG Mi;FAN Dongdong;LI Miao;LI Yuanhai(Department of Anesthesiology,Huainan Xinhua Hospital Affiliated to Anhui University of Science and Technology,Huainan,Anhui 232052,China;Department of Anesthesiology,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽理工大学附属淮南新华医院麻醉科,安徽淮南232052 [2]安徽医科大学第一附属医院麻醉科,安徽合肥230022

出　　处：《安徽医药》2023年第8期1646-1650,共5页Anhui Medical and Pharmaceutical Journal

基　　金：安徽理工大学校级重点项目(fsyyzd2020-05)。

摘　　要：目的研究老年股骨颈骨折病人入院后即刻行连续腰丛阻滞预防性镇痛对住院时间、疼痛的改善程度及住院期间全身情况的影响。方法选取2021年1月至2022年7月安徽理工大学附属淮南新华医院骨科收治老年股骨颈骨折病人54例,按入院后即刻镇痛处理情况分为两组:连续腰丛阻滞镇痛组(N组)及常规镇痛药处理组(C组),各27例。主要观察指标为病人住院时间;次要观察指标包括术前术后视觉模拟评分(VAS);入院后睡眠质量;血清炎性指标;术后不良反应发生率;术后髋关节外展活动度和屈曲度;术后切口引流量;首次下床活动时间。结果N组住院时间[(6.78±0.80)d比(8.96±1.79)d]、术后首次下床活动时间[(41.67±6.83)h比(56.85±10.00)h]均短于C组(P<0.05);N组病人入院即刻阻滞后30 min静息VAS评分较阻滞前明显下降(P<0.05);N组术后的静息及运动VAS评分明显低于C组(P<0.05),差异有统计学意义;N组病人入院后术前睡眠质量优于C组[(3.59±0.97)分比(6.59±1.01)分,P<0.05];N组病人术前术后血清炎性因子水平、术后切口引流量[(31.67±10.00)mL比(70.00±21.79)mL]及术后不良反应发生例数(5比15)明显低于C组(P<0.05)。结论入院后即刻行连续腰丛神经阻滞预防性镇痛,能有效缩短老年股骨颈骨折病人住院时间,降低疼痛程度,降低并发症发生率,促进病人早期快速康复。Objective To study the effect of continuous lumbar plexus block prophylactic analgesia on the length of hospital stay,the improvement of pain and the general condition of elderly patients with femoral neck fracture immediately after admission.Methods From January 2021 to July 2022,54 elderly patients with femoral neck fracture treated in the Department of Orthopaedics of Huainan Xinhua Hospital Affiliated to Anhui University of Technology were randomly divided into two groups according to the immediate analgesic treatment after admission:continuous lumbar plexus block analgesia group(N group,n=27)and conventional analgesics treatment group(C group,n=27).The main outcome measures were the length of stay;Secondary outcome measures included preoperative and postoperative pain score(VAS);Sleep quality after admission;Serum inflammatory index;The incidence of postoperative adverse reactions;Abduction range of motion and flexion of hip joint after operation;Postoperative incision drainage;First time out of bed activity time.Results The hospitalization time[(6.78±0.80)d vs.(8.96±1.79)d]and the first postoperative ambulation time[(41.67±6.83)h vs.(56.85±10.00)h]in group N were shorter than those in group C(P<0.05);In group N,the resting VAS score at 30 min after immediate block was significantly lower than that before block(P<0.05);The VAS scores of rest and exercise in group N were significantly lower than those in group C(P<0.05);The preoperative sleep quality of patients in group N was better than that of patients in group C[(3.59±0.97)vs.(6.59±1.01),P<0.05];The levels of serum inflammatory factors,postoperative incision drainage volume[(31.67±10.00)mL vs.(70.00±21.79)mL]and the incidence of postoperative adverse reactions(5 vs.15)in group N were significantly lower than those in group C(P<0.05).Conclusion Prophylactic analgesia with continuous lumbar plexus nerve block immediately after admission can effectively shorten the length of hospital stay,reduce the degree of pain,reduce the incidence of complication

关 键 词：股骨颈骨折 麻醉和镇痛 腰骶丛 入院即刻 老年人 髋关节置换 加速康复外科 

分 类 号：R614[医药卫生—麻醉学]