髋关节囊周围神经丛阻滞联合股外侧皮神经阻滞用于髋部骨折手术效果观察  

Perioperative effect of pericapsular nerve group block combined with lateral femoral cutaneous nerve block on patients under-going hip surgery

作　　者：项明琼 张敏[1] 陈昼琳 谢飞 田涛 杨志萍[1] XIANG Mingqiong;ZHANG Min;CHEN Zhoulin;XIE Fei;TIAN Tao;YANG Zhiping(Department of Anesthesiology,Yangpu District Central Hospital(Yangpu Hospital,School of Medicine,Tongji University),Shanghai 200090,China)

机构地区：[1]上海市杨浦区中心医院(同济大学附属扬浦医院)麻醉科,200090

出　　处：《浙江医学》2024年第18期1974-1978,共5页Zhejiang Medical Journal

基　　金：上海市杨浦区中心医院院级课题项目(Se1202112)。

摘　　要：目的观察超声引导下髋关节囊周围神经丛阻滞(PENGB)联合股外侧皮神经阻滞(LFCNB)用于髋部骨折手术的效果。方法选择2022年2月至2023年6月在上海市杨浦区中心医院因髋部骨折行人工股骨头置换术或股骨转子间骨折闭合复位髓内钉内固定术患者60例,按随机数字表法分为神经阻滞组和对照组,每组30例。神经阻滞组于蛛网膜下腔阻滞体位摆放前30 min行PENGB及LFCNB,对照组于体位摆放前5 min静脉给予枸橼酸舒芬太尼0.1μg/kg。记录所有患者术前、神经阻滞后30 min或静脉用药后5 min、体位摆放时的视觉模拟评分法(VAS)评分及患者配合程度、术后6、12、24和48 h的VAS评分、术后6 h患侧下肢肌力、术前和术后CRP、血清淀粉样蛋白A(SAA)、术中及术后短期并发症的发生情况及患者满意度。结果两组患者术前VAS评分比较差异无统计学意义(P>0.05);神经阻滞或静脉用药后,VAS评分均明显改善(均P<0.05),且神经阻滞组优于对照组(P<0.05);蛛网膜下腔阻滞摆放体位时,神经阻滞组VAS评分和患者配合度均优于对照组(均P<0.05);神经阻滞组术后6、12和24 h活动VAS评分及术后12、24 h的静息VAS评分均优于对照组(均P<0.05);两组患者术后6 h患侧下肢肌力及术后短期并发症发生率比较差异均无统计学意义(均P>0.05);两组患者术后CRP及SAA均高于术前(均P<0.01),但组间比较差异均无统计学意义(均P>0.05);神经阻滞组患者满意度高于对照组(P<0.05)。结论PENGB联合LFCNB可以有效减轻髋部骨折患者围术期疼痛、提高患者配合度及满意度、对术后患侧下肢肌力及炎症反应没有影响,可以安全应用于临床。Objective To observe the effect of ultrasound-guided pericapsular nerve group block(PENGB)combined with lateral femoral cutaneous nerve block(LFCNB)on hip fracture patients underwent surgery.Methods Sixty patients underwent artificial femoral head replacement for hip fracture or intramedullary nail fixation for closed reduction of intertrochanteric fracture of femur in Yangpu District Central Hospital from February 2022 to June 2023 were selected and randomly divided into the nerve block group and the control group by random number,30 cases in each group.In the nerve block group,PENGB and LFCNB were performed 30 min before positioning for subarachnoid block,while in the control group,sufentanil citrate 0.1μg/kg was given intravenously 5 min before positioning.For all patients,Visual Analogue Scale(VAS)scores at entry,30 min after PENGB block or 5 min after sufentanil were recorded,as well as patient cooperation,pain VAS scores at 6,12,24,and 48 h after surgery,muscle strength of the affected lower extremity at 6 h after surgery,preoperative and postoperative CRP and serum amyloid A(SAA),occurrence of intraoperative and postoperative short-term complications,and patient satisfaction.Results There was no difference in preoperative pain VAS scores between the two groups(P>0.05).The pain was significantly improved after either nerve block or intravenous sufentanil(both P<0.05),but the VAS score in nerve block group was significantly lower than that of control group(P<0.05).When patients were positioned for subarachnoid block,the VAS score(both P<0.05)and patient coordination(P<0.05)in nerve block group were both significantly superior to the control group(both P<0.05).The active VAS scores at 6,12 and 24 h after operation and the resting VAS scores at 12 and 24 h after operation in nerve block group were all superior to the control group(all P<0.05).There was no significant difference in the other time points,neither in muscle strength of lower extremity at 6 h after operations and complication rate.Postoperative CR

关 键 词：关节囊周围神经丛阻滞 股外侧皮神经阻滞 髋部骨折 

分 类 号：R614[医药卫生—麻醉学]