髂腰肌平面阻滞与腹股沟韧带上髂筋膜间隙阻滞对髋部骨折早期镇痛效果的比较  

Comparison of the early analgesic effect of iliopsoas plane block versus supra-inguinal fascia iliaca compartment block in patients with hip fracture

作　　者：刘鹏程 韩妤妤 公金燕 于雪 唐鲁 高成杰 王飞 Liu Pengcheng;Han Yuyu;Gong Jinyan;Yu Xue;Tang Lu;Gao Chengjie;Wang Fei(Postgraduate Training Base of Jinzhou Medical University(the 960th Hospital of the People's Liberation Army),Jinan 250031,China;Department of Anesthesiology,the 960th Hospital of the People's Liberation Army,Jinan 250031,China;School of Anesthesiology,Shandong Second Medical University,Weifang 261053,China;The Second Clinical Medical College,Shandong University of Tradition-al Chinese Medicine,Jinan 250355,China;Department of Stomatology,the 960th Hospital of the People's Liberation Army,Jinan 250031,China)

机构地区：[1]锦州医科大学研究生培养基地(解放军第九六〇医院),济南250031 [2]解放军第九六〇医院麻醉科,济南250031 [3]山东第二医科大学麻醉学院,潍坊261053 [4]山东中医药大学第二临床医学院,济南250355 [5]解放军第九六〇医院口腔科,济南250031

出　　处：《国际麻醉学与复苏杂志》2024年第4期366-371,共6页International Journal of Anesthesiology and Resuscitation

基　　金：济南市临床医学科技创新计划(202019018,202019025)。

摘　　要：目的比较髂腰肌平面阻滞(IPB)和腹股沟韧带上髂筋膜间隙阻滞(S⁃FICB)在髋部骨折患者早期镇痛中的效果。方法按随机数字表法将50例髋部骨折患者分为两组(每组25例):IPB组和S⁃FICB组。IPB组在髂股韧带和髂腰肌之间注射0.5%罗哌卡因10 ml,S⁃FICB组在腹股沟韧带上髂筋膜间隙注射0.375%罗哌卡因30 ml。记录神经阻滞前(T0)、阻滞后10 min(T1)、阻滞后30 min(T2)、阻滞后2 h(T3)、阻滞后4 h(T4)、阻滞后6 h(T5)和阻滞后12 h(T6)的静息和抬髋15°时视觉模拟评分法(VAS)疼痛评分及T1~T6的徒手肌力评定(MMT)评分。记录两组患者神经阻滞起效时间、操作时间、患者镇痛满意度、补救镇痛药物使用情况和镇痛期间不良反应发生情况。结果与T0比较,两组患者T1~T6静息和抬髋15°时的VAS疼痛评分明显降低(均P<0.05)。与S⁃FICB组比较,IPB组患者T2~T6静息和抬髋15°时的VAS疼痛评分明显较低(均P<0.05),T1~T6静息和抬髋15°时的MMT评分明显较高(均P<0.05),起效时间和操作时间明显较短(P<0.05),镇痛满意度评分明显较高(P<0.05)。两组患者均未出现神经阻滞相关不良反应及补救镇痛情况。结论IPB和S⁃FICB对髋部骨折患者均有良好的镇痛效果。IPB的镇痛效果更好,操作所需时间较少,起效较快,患者满意度更高,是髋部骨折早期镇痛安全、有效的方法。Objective To compare the effect of iliopsoas plane block(IPB)versus supra⁃inguinal fascia iliaca compartment block(S⁃FICB)for early analgesia in patients with hip fracture.Methods According to the random number table method,50 pa⁃tients with hip fracture were divided into two groups(n=25):an IPB group and a S⁃FICB group.Patients in the IPB group were injected with 0.5%ropivacaine at 10 ml between the iliopsoas muscle and the iliofemoral ligament,while those in the S⁃FICB group were inject⁃ed with 0.375%ropivacaine at 30 ml in the supra⁃inguinal fascia iliaca compartment.Then,the Visual Analogue Scale(VAS)scores were recorded before nerve block(T0),10 min after nerve block(T1),30 min after nerve block(T2),2 h after nerve block(T3),4 h after nerve block(T4),6 h after nerve block(T5)and 12 h after nerve block(T6)and the Manual Muscle Test(MMT)scores at T1 to T6 at resting and with the hip positioned at 15°of flexion were recorded.Their time to onset of nerve block,operation time,patient satisfac⁃tion with analgesia,rescue analgesic use and the incidence of adverse reactions were also recorded.Results Compared with those at T0,both groups showed remarkable decreases in VAS scores at T1 to T6 at resting and with the hip positioned at 15°of flexion(all P<0.05).Compared with the S⁃FICB group,the IPB group presented significant decreases in VAS scores at T2 to T6 at resting and with the hip positioned at 15°of flexion(all P<0.05),significant increases in MMT scores at T1 to T6 at resting and with the hip positioned at 15°of flexion(all P<0.05),and reductions in the onset time and operation time(P<0.05),with significant improvement in patient sat⁃isfaction score with analgesia(P<0.05).There were no adverse reactions related to nerve block or rescue analgesic use in both groups.Conclusions Both IPB and S⁃FICB have good analgesic effect on patients with hip fracture.However,IPB shows more effective anal⁃gesic effect,which takes less time than S⁃FICB,with faster effect and higher patient satisfa

关 键 词：髂腰肌平面阻滞 腹股沟韧带上髂筋膜间隙阻滞 髋部骨折 镇痛 

分 类 号：R68[医药卫生—骨科学]