超声引导下不同入路髂筋膜阻滞在老年髋部骨折患者行椎管内麻醉摆放体位过程中及术后的镇痛效果比较  

Comparison of analgesic effects of ultrasound-guided different approaches of iliac fascia block on elderly patients with hip fracture in intraspinal anesthesia during positioning and postoperative

作　　者：马亚芳 毕星 陈治富 MA Yafang;BI Xing;CHEN Zhifu(Anesthesiology Department,Baoji People's Hospital,Baoji 721000,China)

机构地区：[1]宝鸡市人民医院麻醉科,陕西宝鸡721000

出　　处：《临床医学研究与实践》2024年第3期33-36,共4页Clinical Research and Practice

基　　金：陕西省重点研发计划项目(No.2021SF-265)。

摘　　要：目的比较超声引导下不同入路髂筋膜阻滞对老年髋部骨折患者行椎管内麻醉摆放体位过程中及术后的镇痛效果。方法选择2020年12月至2021年12月于我院择期行椎管内麻醉下髋关节置换术的60例髋部骨折患者为研究对象,按照随机数字表法将其分为A组和B组,每组30例。A组行髂前上棘下入路髂筋膜阻滞,B组行髂前上棘上入路髂筋膜阻滞。比较两组的麻醉效果。结果B组的股外侧皮神经阻滞起效时间短于A组,差异具有统计学意义(P<0.05)。阻滞后10 min(T_(1))~体位摆放时(T_(3)),B组的视觉模拟评分法(VAS)评分低于A组,差异具有统计学意义(P<0.05)。术后6 h(H_(0))~术后10 h(H_(2)),B组的自控镇痛泵使用次数少于A组,差异具有统计学意义(P<0.05)。B组的不良事件总发生率低于A组,差异具有统计学意义(P<0.05)。结论髂前上棘上入路髂筋膜阻滞能够缩短老年髋部骨折患者股外侧皮神经阻滞起效时间,减轻疼痛程度,减少自控镇痛泵使用次数,镇痛效果更好,值得临床推广。Objective To compare the analgesic effects of ultrasound-guided different approaches of iliac fascia block on elderly patients with hip fracture in intraspinal anesthesia during positioning and postoperative.Methods From December 2020 to December 2021,60 patients with hip fracture who underwent hip replacement under intraspinal anesthesia in our hospital were selected as the research objects.The patients were divided into group A and group B according to the random number table method,with 30 cases in each group.The group A underwent iliac fascia block via anterior superior iliac spine under approach,and the group B underwent iliac fascia block via anterior superior iliac spine upper approach.The anesthetic effects of the two groups were compared.Results The onset time of lateral femoral cutaneous nerve block in the group B was shorter than that in the group A,and the difference was statistically significant(P<0.05).From 10 min after block(T_(1))to position placement(T_(3)),the Visual Analogue Score(VAS)score of the group B was lower than that of the group A,and the difference was statistically significant(P<0.05).From 6 h(H_(0))to 10 h(H_(2))after operation,the number of self-controlled analgesia pump use in the group B was less than that in the group A,and the difference was statistically significant(P<0.05).The total incidence of adverse events in the group B was lower than that in the group A,and the difference was statistically significant(P<0.05).Conclusion Iliac fascia block via anterior superior iliac spine upper approach can shorten the onset time of lateral femoral cutaneous nerve block in elderly patients with hip fracture,reduce the degree of pain,reduce the number of self-controlled analgesia pump use,and has better analgesic effect,which is worthy of clinical promotion.

关 键 词：髋部骨折 髂筋膜阻滞 椎管内麻醉 髂前上棘下入路 髂前上棘上入路 

分 类 号：R687.3[医药卫生—骨科学]