腹股沟韧带上髂筋膜间隙阻滞在膝关节表面置换术后镇痛的临床应用  

EFFECT OF CONTINUOUS SUPRAINGUINAL FASCIA ILIACA COMPARTMENT BLOCK NEAR ANTERI-OR SUPERIOR ILIAC SPINE IN ANALGESIA AFTER TOTAL KNEE ARTHROPLASTY

作　　者：陆立仁 郑映金 谢宇宁 邓双钊 梁昌河 LU Liren;ZHENG Yingjin;XIE Yuning;DENG Shuangzhao;LIANG Changhe(Department of Anesthesiology,The Sirth Affiliated Hospital,South China University of Technology,Foshan 528000,China)

机构地区：[1]华南理工大学附属第六医院麻醉科(广东省佛山市南海区人民医院麻醉科),广东省佛山市528000

出　　处：《中国煤炭工业医学杂志》2023年第3期325-331,共7页Chinese Journal of Coal Industry Medicine

基　　金：广东省医学科学技术研究基金(编号:A2021111);广东佛山市医学类科技攻关项目(编号:2020001005274)。

摘　　要：目的探讨超声引导下髂前上棘旁持续性髂筋膜间隙神经阻滞在全膝关节表面置换术后镇痛的临床效果。方法择期全膝关节表面置换术患者采用随机数字表法,依据纳入标准及剔除标准分为3组:腹股沟韧带上组(U组)31例、腹股沟韧带下组(D组)30例、股神经组(F组)30例,按照双盲设计完成研究。记录三组患者股神经、股外侧皮神经及闭孔神经感觉阻滞情况;视觉模拟评分(VAS)测定静息状态和运动状态下疼痛情况;改良Bromage评分测定患肢肌力情况;记录首次下床活动时间;计算术中舒芬太尼用量和七氟烷用量;记录术后补救镇痛次数;采用WHO标准评定恶心呕吐情况。结果三组患者股神经均阻滞成功(P>0.05),U组与D组患者股外侧皮神经阻滞均优于F组(P<0.05),U组闭孔神经阻滞均优于D组与F组(P<0.05)。术后U组4h、6h、12h、24h静息状态下VAS评分分别为1(0,1)分、2(1,2)分、4(3,4)分、3(3,4)分,均优于D组2(1,2)分、3(2,3)分、5(4,5)分、4(4,5)分和F组2(2,3)分、3(2,3)分、5(5,6)分、4(4,5)分,差异有统计学意义(P<0.05);术后4h、12h、24h、48h运动状态下三组患者VAS评分差异均有统计学意义(P<0.05),术后4hU组VAS评分2(1,2)分优于F组2(2,3)分(P<0.05),术后24hU组VAS评分5(4,6)分优于D组6(5,6)分(P<0.05),术后12h、48hU组VAS评分5(5,6)分、3(2,3)分均优于D组6(6,7)分、3.5(3,4)分和F组7(6,7)分、4(3,4)分(P<0.05)。三组患者术后各时间点患肢肌力改良Bromage评分比较差异均无统计学意义(P>0.05);三组患者术后首次下床活动时间分别为(6.13±1.15)h、(6.73±1.14)h、(7.63±1.10)h,差异有统计学意义(P<0.05),U组最早,D组次之,F组最晚。术后补救镇痛次数三组分别为2(1,2)次、3(2,4)次、3(3,4)次,差异有统计学意义(P<0.05),U组均少于D组和F组。三组患者舒芬太尼标准化用量分别为:(0.35±0.05)μg/kg、(0.44±0.06)μg/kg、(0.57±0.08)μg/kg及七氟烷标准化用量分别为:(0.39±0.07)ml/kObjective To investigate the clinical effect of ultrasound-guided continuous suprainguinal fascia iliaca compartment block(SIFICB)near the anterior superior iliac spine in analgesia after total knee arthroplasty(TKA).Methods Patients undergoing elective total knee arthroplasty were randomly divided into 3 groups according to inclusion criteria and exclusion criteria:31 cases in SIFICB near the anterior superior iliac spine(group U),30 cases in the inferior iliac fascia space nerve block(group D),and 30 cases in the femoral nerve block(group F)were performed according to the"double-blinded"experimental design.The efficacy of femoral nerve,lateral femoral cutaneous nerve and obturator nerve was evaluated in the three groups.Score of resting state and functional exercise was measured by visual analogue scale(VAS)at 1h.4h.6h,12h,24h and 48h after operation.Modified Bromage score was used to determine the muscle strength of the operative limb.The time of the first ambulation was recorded.The standardized dosage of sufentanil and sevoflurane during operation were calculated.The times of tramadol remedies for analgesia were recorded.Nausea and vomiting were evaluated by WHO criteria.Results Femoral nerve was successfully blocked in all three groups(P>O.05),the efficacy of lateral femoral cutaneous nerve was blocked in group U or group D was better than that in group F(P<0.05),and the blockage of obturator nerve in group U was better than that in group D or group F(P<0.05).In resting state at 4h,6h,12h and 24h after operation,the VAS score of group U were 1(0,1)points,2(1,2)points,4(3,4)points and 3(3,4)points,which were significantly lower than 2(1,2)points,3(2,3)points,5(4,5)points,4(4,5)points of group D or 2(2,3)points,3(2,3)points,5(5,6)points,4(4,5)points of group F(P<0.05).The VAS score of patients among the three groups was significant difference in functional exercise at 4h,12h,24h and 48h after operation(P<0.05),VAS score of group U was 2(1,2)point lower than 2(2,3)point of group F at 4 h after operation(P<0.05

关 键 词：腹股沟韧带上髂筋膜间隙神经阻滞 全膝关节表面置换术 镇痛 超声引导 髂前上棘 

分 类 号：R614.2[医药卫生—麻醉学]