超声引导下不同入路髂筋膜间隙阻滞在老年髋关节置换术中的镇痛效果  

Effect of different approaches of iliac fascial space block under ultrasound guidance in elderly patients undergoing hip replacement

作　　者：李彦平[1] 方圆 张旭[1] 马玉林[1] 石磊[1] LI Yan-ping;FANG Yuan;ZHANG Xu;MA Yu-lin;SHI Lei(Department of Anesthesiology,Ankang Central Hospital,Ankang 725000,Shaanxi,CHINA)

机构地区：[1]安康市中心医院麻醉科,陕西安康725000

出　　处：《海南医学》2023年第23期3428-3432,共5页Hainan Medical Journal

基　　金：陕西省科学技术研究发展计划项目(编号:2016SF-248)。

摘　　要：目的观察超声引导下不同入路髂筋膜间隙阻滞(FICB)在老年髋关节置换术(THA)中的镇痛效果。方法选取2021年10月至2022年10月安康市中心医院收治的80例拟行THA的老年患者为研究对象,根据随机数表法将患者分为A组和B组,每组各40例。A组患者采用超声引导下内侧入路FICB,B组患者采用超声引导下外侧入路FICB。比较两组患者围术期指标[手术时间、术中出血量、复苏室停留时间、术后拔管时间、术后48 h视觉疼痛模拟(VAS)评分、舒芬太尼使用量、第一次下床活动时间、住院时间]、术后阻滞指标(穿刺注药时间、置管时间、导管重新固定例数、置管深度)、手术前后应激反应指标[血清去甲肾上腺素(NE)、皮质醇(Cor)水平、C反应蛋白(CRP)]、手术前后疼痛介质指标[血清P物质(SP)、神经肽Y(NPY)、前列腺素E2(PGE2)及5-羟色胺(5-HT)]以及不良反应发生情况。结果A组患者术后48 h的VAS评分为(2.43±0.45)分,明显低于B组的(3.48±0.52)分,差异有统计学意义(P<0.05),两组患者的手术时间、术中出血量、复苏室停留时间、术后拔管时间、舒芬太尼使用量、第一次下床活动时间及住院时间比较差异均无统计学意义(P>0.05);术后,A组患者的导管重新固定例数占比为5.00%,明显少于B组的25.00%,置管时间为(63.29±8.36)s,明显短于B组的(155.40±9.25)s,置管深度为(11.13±1.27)cm,明显大于B组的(7.09±1.18)cm,差异均具有统计学意义(P<0.05),但两组患者的穿刺注药时间比较差异无统计学意义(P>0.05);术后1 d,A组患者的NE、CRP、Cor水平分别为(236.16±16.33)pg/mL、(7.18±0.64)mg/L、(193.62±24.19)pg/mL,明显低于B组的(289.29±27.12)pg/mL、(12.40±1.41)mg/L、(235.39±26.31)pg/mL,差异均有统计学意义(P<0.05);术后1 d,A组患者的NPY、SP、PGE2、5-HT水平分别为(68.68±7.51)pg/mL、(72.14±8.38)pg/mL、(28.99±5.32)ng/mL、(0.64±0.14)μmol/L,明显低于B组的(81.29±8.45)pg/mL、(95.68±Objective To study the effect of ultrasound-guided iliac fascial space block(FICB)in elderly patients undergoing hip replacement(THA).Methods Eighty elderly patients with THA admitted to Ankang Central Hospital from October 2021 to October 2022 were selected and randomly divided into group A and group B,with 40 patients in each group.Patients in group A were treated with ultrasound-guided medial approach FICB,while those in group B were treated with ultrasound-guided lateral approach FICB.The perioperative indicators of two groups[surgical time,intraoperative bleeding volume,length of resuscitation room stay,postoperative extubation time,Visual Analogue Scale(VAS)score at 48 hours after surgery,sufentanil usage,time of first out-of-bed activity,length of hospital stay],and postoperative block indicators[puncture injection time,catheterization time,number of cases with re-fixation of catheter,depth of catheterization],stress response indicators before and after surgery[serum norepinephrine(NE),cortisol(Cor)levels,C-reactive protein(CRP)],pain mediators before and after surgery[serum substance P(SP),neuropeptide Y(NPY),prostaglandin E2(PGE2),and 5-hydroxytryptamine(5-HT)],as well as the occurrence of adverse reactions were compared between the two groups.Results The VAS score of group A at 48 hours after operation was(2.43±0.45)points,which was significantly lower than(3.48±0.52)points of group B(P<0.05).There was no statistically significant difference between the two groups in terms of surgical time,intraoperative bleeding volume,length of resuscitation room stay,postoperative extubation time,sufentanil usage,time of first out-of-bed activity,and length of hospital stay(P>0.05).The number of cases with re-fixation of catheter in group A was 5.00%,which was significantly less than 25.00%in group B;catheterization time was(63.29±8.36)s,which was significantly shorter than(155.40±9.25)min in group B;the depth of catheterization was(11.13±1.27)cm,which was significantly longer than(7.09±1.18)cm in group B;the d

关 键 词：全髋关节置换术 髂筋膜间隙阻滞 超声 内侧入路 外侧入路 镇痛效果 

分 类 号：R687.4[医药卫生—骨科学]