IPB复合全麻对髋关节置换术患者围术期镇痛效果及术后股四头肌肌力的影响  

Effect of IPB combined with general anesthesia on perioperative analgesia and postoperative quadriceps muscle strength in patients undergoing hip replacement

作　　者：陈慧霞 魏俊生[1] 邱六怀 CHEN Hui-xia;WEI Jun-sheng;QIU Liu-huai(Department of Anesthesiology,the Second People's Hospital of Chizhou,Chizhou 247000,Anhui,China)

机构地区：[1]池州市第二人民医院麻醉科,安徽池州247000

出　　处：《川北医学院学报》2024年第9期1179-1182,共4页Journal of North Sichuan Medical College

基　　金：安徽省自然科学基金(2008085QH383)。

摘　　要：目的:探讨髋关节置换术中行髂腰肌平面阻滞(IPB)复合全麻的围术期镇痛效果及其对患者术后股四头肌肌力的影响。方法:将98例行髋关节置换术的患者按照接受麻醉方案不同分为对照组与观察组,每组各49例。全麻诱导前,观察组行IPB;对照组行髂筋膜间隙阻滞(FICB),两组均予以0.375%罗哌卡因30 mL注射。术毕均行静脉自控镇痛。记录两组术后2、6、12及24 h静息和活动时疼痛评分;记录并比较两组术中麻醉药物使用量、术后镇痛情况;记录两组患者术后2、6、24及48 h股四头肌肌力评分;记录两组术后恢复情况和不良反应发生情况。结果:两组术后2~24 h的VAS评分(静息、活动时)、术中麻醉药物用量、补救镇痛率及镇痛泵按压次数无统计学差异(P>0.05)。较于对照组,观察组术后2~24 h股四头肌肌力均更高(P<0.05)。与对照组相比,观察组下床活动更早(P<0.05),首次步行距离更长(P<0.05),术后住院时间更短(P<0.05)。两组不良反应总发生率无统计学差异(P>0.05)。结论:在全麻髋关节置换术中,IPB可为患者提供良好镇痛,且较于FICB,保留了股四头肌肌力,利于患者术后快速恢复。Objective:To investigate the effect of iliopsoas plane block(IPB)combined with general anesthesia on perioperative analgesia and postoperative quadriceps muscle strength in patients undergoing hip replacement.Methods:A total of 98 patients with hip replacement were divided into control group and observation group according to the different anesthesia regimen,with 49 cases in each group.Before induction of general anesthesia,IPB was performed in the observation group and fascia iliaca compartment block(FICB)was performed in the control group.Both groups were injected with 30 mL of 0.375%ropivacaine.Patient-controlled intravenous analgesia was performed after operation.The pain scores at rest and during activity at 2,6,12 and 24 h after operation were recorded in the two groups.The amount of anesthetic drugs used in the two groups and postoperative analgesia were recorded.The muscle strength scores of quadriceps femoris were recorded at 2,6,24 and 48 h after operation.The postoperative recovery and adverse reactions of the two groups were recorded.Results:There were no significant differences in VAS scores at rest and during activity at 2~24 h after operation,intraoperative remifentanil dosage,analgesic pump pressing times between the two groups(P>0.05).Compared with the control group,the quadriceps muscle strength of the observation group was higher at 2~24 h after operation(P<0.05).Compared with the control group,the first time of getting out of bed in the observation group was shortened(P<0.05),the first walking distance was increased(P<0.05),and the postoperative hospitalization time was also shortened(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:IPB can provide good analgesia for patients undergoing hip replacement under general anesthesia.Compared with FICB,IPB retains the muscle strength of quadriceps femoris,which is conducive to the rapid recovery of patients after operation.

关 键 词：髋关节置换术 髂腰肌平面阻滞 髂筋膜间隙阻滞 镇痛 运动功能 

分 类 号：R614[医药卫生—麻醉学]