超声引导下连续股神经阻滞联合单次髋关节囊局部浸润麻醉在老年髋关节置换术前镇痛中的应用效果  

Effect of ultrasound guided continuous femoral nerve block combined with single local infiltration anesthesia of hip joint capsule on analgesia before hip replacement in the elderly and its influence on stress indicators and pain mediators

作　　者：王莉[1] 赵永军[1] 翟浩宇 黄小俊[2] 仇丽雅 WANG Li;ZHAO Yongjun;ZHAI Haoyu;HUANG Xiaojun;QIU Liya(Department of Anesthesiology,The First People′s Hospital of Guangyuan,Guangyuan 628017,Sichuan,China;Department of Orthopedics,The First People′s Hospital of Guangyuan,Guangyuan 628017,Sichuan,China)

机构地区：[1]广元市第一人民医院麻醉科,四川广元628017 [2]广元市第一人民医院骨科,四川广元628017

出　　处：《西部医学》2023年第12期1831-1835,共5页Medical Journal of West China

基　　金：2019年四川省医学会(青年创新)科研课题(S19006)。

摘　　要：目的观察超声引导下连续股神经阻滞联合单次髋关节囊局部浸润麻醉在老年髋关节置换术前镇痛中的应用效果及对应激指标、疼痛介质的影响。方法选取2018年1月—2022年3月在我院行髋关节置换术的老年患者98例,采用随机数字法分为对照组(n=49)和观察组(n=49)。对照组采用单次髋关节囊局部浸润麻醉,观察组采用超声引导下连续股神经阻滞联合单次髋关节囊局部浸润麻醉。比较两组手术情况(感觉阻滞时间、术后下床活动时间、疼痛恢复时间等)。采用视觉模拟(VAS)评分评估两组术后不同时间患者疼痛程度;记录两组术后0~24 h、24~48 h内阿片类药物剂量;检测两组手术前后应激指标[血糖、C反应蛋白(CRP)]及疼痛介质[5-羟色胺(5-HT)、P物质(SP)]的差异。结果观察组感觉阻滞和疼痛恢复时间长于对照组,术后下床活动和住院时间短于对照组,术后6、12、24及48 h时静息和运动状态下的VAS评分均低于对照组(P<0.05),苏醒和喉管拔除时间与对照组比较差异无统计学意义(P>0.05)。术前两组患者的应激指标及疼痛介质水平比较,差异无统计学意义(P>0.05),术后48 h,观察组血糖、CRP、5-HT、SP较术前升高,观察组术后48 h上述指标低于对照组(P<0.05)。观察组术后0~24 h、24~48 h内阿片类药物剂量明显低于对照组(P<0.05)。98例患者术后未发生麻醉相关不良反应。结论超声引导下连续股神经阻滞联合单次髋关节囊局部浸润麻醉可以减轻老年髋关节置换术患者的应激反应,降低疼痛物质的释放,从而减轻术后疼痛,减少阿片类药物的应用,促进术后恢复。Objective To observe the effect of ultrasound guided continuous femoral nerve block combined with single local infiltration anesthesia of hip joint capsule on the analgesia before hip replacement in the elderly and its influence on stress indicators and pain mediators.Methods A total of 98 elderly patients who underwent hip replacement in our hospital from January 2018 to March 2022 were selected and divided into the two groups by random number method.The control group received a single local infiltration anesthesia of the hip joint capsule,while the observation group received ultrasound-guided continuous femoral nerve block combined with a single local infiltration anesthesia of the hip joint capsule.The surgical conditions(sensory block time,postoperative ambulation time,pain recovery time,etc.)were compared between the two groups,and the visual analog(VAS)score was used to evaluate the pain degree of the two groups at different times after the operation,and the two groups were recorded from 0 to 24 hours after the operation.,Opioid doses within 24-48h,and differences in stress indicators[blood glucose,C-reactive protein(CRP)]and pain mediators[5-hydroxytryptamine(5-HT),substance P(SP)]before and after surgery were detected between the two groups.Results The recovery time of sensory block and pain in the observation group was longer than that in the control group,and the time of getting out of bed and hospitalization after operation was shorter than that in the control group.The VAS scores at rest and exercise at 6h,12h,24h and 48h after operation were lower than those in the control group.The time of awakening and laryngeal tube removal had no statistical significance compared with the control group(P>0.05).Before surgery,there was no statistical significance in the comparison of stress indicators and pain mediators between the two groups(P>0.05).At 48 hours after operation,blood glucose,CRP,5-HT and SP in the observation group were higher than those before operation,and the above indexes in the observation gr

关 键 词：髋关节置换术 超声引导 连续股神经阻滞 局部浸润麻醉 疼痛 阿片类药物 

分 类 号：R687[医药卫生—骨科学]