超声引导下髋关节囊周围神经阻滞与髂筋膜间隙阻滞对老年髋部骨折术后疼痛及恢复影响  

Effects of ultrasound-guided pericapsular nerve group block versus fascia iliaca compartment block on postoperative pain and recovery in elderly patients with hip fractures

作　　者：戚小航[1] 孙东辉[1] 吴振宇[1] 龚姗[2] QI Xiao-hang;SUN Dong-hui;WU Zhen-yu;GONG Shan(Department of Anesthesiology,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院麻醉科,河北秦皇岛066000 [2]秦皇岛市第一医院妇科,河北秦皇岛066000

出　　处：《创伤与急危重病医学》2024年第3期155-158,共4页Trauma and Critical Care Medicine

基　　金：河北省医学科学研究课题计划(20221606)。

摘　　要：目的探讨超声引导下髋关节囊周围神经阻滞(PENGB)与髂筋膜间隙阻滞(FICB)对老年髋部骨折术后疼痛及恢复的影响。方法选取秦皇岛市第一医院自2019年4月至2023年12月收治的80例老年髋部骨折患者为研究对象,按照随机数字表法分为FICB组与PENGB组,每组各40例。患者均接受手术治疗,FICB组在全身麻醉诱导前超声引导下行FICB,PENGB组在全身麻醉诱导前超声引导下行PENGB。比较两组的视觉模拟量表(VAS)评分,感觉阻滞有效率,术中丙泊酚和瑞芬太尼用量,简易智力状态检查量表(MMSE)评分,不良反应发生率,以及术后1个月的认知功能障碍发生率。结果PENGB组术后6、12、24 h的静息状态下和运动状态下VAS评分均低于FICB组,差异有统计学意义(P<0.05);两组术后48 h的静息状态下和运动状态下VAS评分比较,差异均无统计学意义(P>0.05)。PENGB组术后6、12、24 h的感觉阻滞有效率均高于FICB组,差异有统计学意义(P<0.05);两组术后48 h的感觉阻滞有效率比较,差异无统计学意义(P>0.05)。两组术中丙泊酚用量比较,差异无统计学意义(P>0.05);PENGB组术中瑞芬太尼用量少于FICB组,差异有统计学意义(P<0.05)。两组术前12 h、术后24 h的MMSE评分比较,差异均无统计学意义(P>0.05);PENGB组术后48、72 h的MMSE评分均高于FICB组,差异有统计学意义(P<0.05)。两组不良反应发生率和认知功能障碍发生率比较,差异均无统计学意义(P>0.05)。结论与全身麻醉复合超声引导下采用FICB比较,采用PENGB在老年髋部骨折术中可取得更好的镇痛效果,术中麻醉药物用量更小,更利于患者术后认知功能恢复。Objective To investigate the effects of ultrasound-guided pericapsular nerve group block(PENGB)versus fascia iliaca compartment block(FICB)on postoperative pain and recovery in elderly patients with hip fractures.Methods Eighty elderly patients with hip fractures treated at Qinhuangdao First Hospital from April 2019 to December 2023 were selected as study subjects and randomly divided into FICB group and PENGB group,with 40 cases in each group.All patients underwent surgical treatment.The FICB group received ultrasound-guided FICB before general anesthesia induction,while the PENGB group received ultrasound-guided PENGB.Visual analogue scale(VAS)scores,effective rates of sensory block,intraoperative propofol and remifentanil dosages,minimental state examination(MMSE)scores,incidence of adverse reactions,and incidence of cognitive dysfunction at 1 month postoperatively were compared between the two groups.Results The VAS scores of PENGB group at 6,12 and 24 h after operation were lower than those of FICB group,and the difference was statistically significant(P<0.05).There was no significant difference in VAS scores between the two groups at rest and exercise 48 h after surgery(P>0.05).The effective rate of sensory block at 6,12 and 24 h after operation in PENGB group was higher than that in FICB group,with statistical significance(P<0.05).There was no significant difference in the effective rate of sensory block 48 h after operation between the two groups(P>0.05).There was no significant difference in intraoperative propofol dosage between the two groups(P>0.05).The dosage of remifentanil in PENGB group was lower than that in FICB group,and the difference was statistically significant(P<0.05).There was no significant difference in MMSE scores between the two groups at 12 h before and 24 h after surgery(P>0.05).The MMSE scores of PENGB group at 48 and 72 h after surgery were higher than those of FICB group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence

关 键 词：髋关节囊周围神经阻滞 髂筋膜间隙阻滞 超声 全身麻醉 髋部骨折 

分 类 号：R614[医药卫生—麻醉学] R74[医药卫生—外科学]