超声引导下高位髂筋膜阻滞对老年患者股骨头置换术后凝血功能的影响  

The effect of ultrasound-guided high iliac fascia block on coagulation function in elderly patients after femoral head replacement

作　　者：刘玲丽 王宏伟 郁万友 王琦 龙云 王立英 何靖 LIU Lingli;WANG Hongwei;YU Wanyou;Wang Qi;LONG Yun;WANG Liying;HE Jing(Department of Anesthesiology,Jiangning Hospital Affiliated to Nanjing Medical Universtiy(Jiangning Clinical Medical College of Jiangsu Vocational College of Medicine),Nanjing 211100;Department of Pain,Yancheng Third People’s Hospital,Yancheng 224000,China)

机构地区：[1]南京医科大学附属江宁医院(江苏医药职业学院江宁临床医学院)麻醉科,江苏南京211100 [2]盐城市第三人民医院疼痛科,江苏盐城224000

出　　处：《南京医科大学学报（自然科学版）》2023年第11期1568-1573,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏医药职业学院校外教学基地科研发展专项课题(20229141)。

摘　　要：目的:探讨超声引导下高位髂筋膜阻滞对股骨头置换老年患者凝血功能的影响。方法:选择在静脉全身麻醉下行股骨头置换的老年患者80例。按随机数字表分为2组,每组40例:观察组在麻醉诱导前30 min行超声引导下高位髂筋膜阻滞然后再行静脉全身麻醉;对照组只行静脉全身麻醉。分别于入院检查时(基础值)、手术开始后1 h、术后24 h抽取肘静脉血进行血栓弹力图分析;离心分离血清,测定血清皮质醇、C-反应蛋白(C-reactive protein,CRP)、白介素(interleukin,IL)-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α水平。记录患者术后6 h(T1)、24 h(T2)、48 h(T3)安静和运动时疼痛数字评分(numerical rating scale,NRS),记录术后不良反应和患者满意度评分。结果:与对照组比较,观察组术后24 h的血栓弹力图反应时间(reac-tion time,R)延长,最大振幅(maximum amplitude,MA)、凝集块形成速率(α)、凝血综合指数(coagulation index,CI)降低(P<0.05)。与入院时比较,对照组患者术后24 h的R值降低,且MA、α、CI升高(P<0.05)。与对照组相比,观察组手术开始后1 h和术后24 h皮质醇、CRP、IL-6和TNF-α的含量低(P<0.05),术后T1~T3时点的静息和运动时NRS低(P<0.05),满意度高(P<0.05),苏醒期躁动和恶心呕吐的发生率低(P<0.05)。结论:超声引导下高位髂筋膜阻滞联合全身麻醉能降低老年患者股骨头置换术中和术后的应激反应和高凝状态,提供较好的术后镇痛效果。Objective:To investigate the effect of ultrasound-guided high iliac fascia block on blood coagulation in elderly patients with femoral head replacement.Methods:Eighty elderly patients undergoing femoral head replacement under intravenous general anesthesia were selected.The patients were divided into two groups according to the random number table,with 40 cases in each group:the observation group underwent ultrasound-guided high fascia iliac block followed by intravenous general anesthesia 30 min before anesthesia induction;the control group only received intravenous general anesthesia.Venous blood samples were collected at admission(baseline),1 h and 24 h after operation for thromboelastography analysis.Serum was separated by centrifugation,and the levels of serum cortisol,C-reactive protein(CRP),interleukin(IL)-6 and tumor necrosis factor(TNF)-αwere determined.Numerical rating scale(NRS)scores were recorded at 6 h(T1),24 h(T2)and 48 h(T3)after operation.Postoperative adverse reactions and patient satisfaction scores were recorded.Results:Compared with the control group,the reaction time(R)value of the observation group was increased at 24 h after operation,and maximum amplitude(MA),αand coagulation index(CI)were decreased(P<0.05).Compared with those at admission,the R value of the control group at 24 hours after operation was decreased,and MA,α,and CI were increased(P<0.05).Compared with the control group,the contents of cortisol,CRP,IL-6 and TNF-αat 1 h and 24 h after operation in the observation group were decreased(P<0.05),the NRS scores at rest and during exercise at T1-T3 after operation were lower(P<0.05),the satisfaction degree was higher(P<0.05),and the incidence of restlessness,nausea and vomiting during the recovery period was lower(P<0.05).Conclusion:Ultrasound-guided high fascia iliaca block combined with general anesthesia can reduce the stress response and hypercoagulable state during and after femoral head replacement in elderly patients,and provide better postoperative analgesia.

关 键 词：超声引导 高位髂筋膜阻滞 股骨头置换术 老年患者 凝血功能 

分 类 号：R614.3[医药卫生—麻醉学]