术前连续髂筋膜间隙阻滞联合右美托咪定滴鼻对老年髋部骨折围术期睡眠质量及术后谵妄的影响  

Effect of preoperative dexmedetomidine combined with fascia iliac compartment block on perioperative sleep quality and delirium in elderly patients with hip fracture

作　　者：邓海泽 蔡剑波 王文凯 周文丹 丁璐菲 DENG Haize;CAI Jianbo;WANG Wenkai;ZHOU Wendan;DING Lufei(Department of Anesthesiology,Huizhou Sixth People’s Hospital,Huizhou City,Guangdong Province 516200,China)

机构地区：[1]广东省惠州市第六人民医院麻醉科,516200

出　　处：《临床外科杂志》2024年第10期1110-1113,共4页Journal of Clinical Surgery

摘　　要：目的探讨术前连续髂筋膜间隙阻滞(FICB)联合右美托咪定(DEX)滴鼻对老年髋部骨折围术期睡眠质量及术后谵妄的影响。方法2021年1月~2023年6月在本院接受全髋关节置换术(THA)治疗髋部骨折的老年病人90例,随机分为对照组、FICB组和联合组三组,每组各30例。对照组术前常规处理,FICB组入院后于术前二天实施超声引导下FICB镇痛,联合组在FICB基础上,术前1天晚上、术后当天及术后第1天晚上给予DEX滴鼻。记录入院时(T1)、滴鼻后30分钟(T2)、入室后过手术床即刻(T3)、椎管内麻醉摆放体位时(T4)的疼痛视觉模拟(VAS)评分。记录术前1天、手术当天及术后1天病人的汉密尔顿焦虑(HAM-A)评分和阿森斯失眠量表(AIS)评分。记录病人不良反应及术后1周发生术后谵妄的情况。结果各组病人的年龄、性别、体重指数和骨折类型、麻醉时长、手术时间、出血量和不良反应(除外日间嗜睡)比较,差异无统计学意义(P>0.05)。联合组病人T2、T3、T4的VAS评分、HAM-A和AIS评分、术后谵妄发生率及持续时间低于短于其他两组,差异有统计学意义(P<0.05)。结论连续FICB联合DEX可缓解THA术前疼痛,改善病人围术期睡眠质量,并降低术后谵妄发生率。Objective To investigate the effect of preoperative dexmedetomidine(DEX)combined with fascia iliac compartment block(FICB)analgesia on perioperative sleep quality and delirium in elderly patients with hip fracture.Methods A total of 90 elderly patients who received total hip replacement(THA)for hip fracture in our hospital from January 2021 to June 2023 were selectively included,and all patients were randomly divided into control group(n=30),FICB group(n=30)and combination group(n=30).Patients in control group were prepared according to routine surgical procedures before surgery.Patients in combination group and FICB group were given continuous ultrasus-guided iliofascial space block and analgesia two days before surgery after admission.Patients in combination group were given dexmedetomidine nose drops on the night before surgery,the day after surgery and the night after surgery.Visual analogue pain(VAS)scores were recorded at admission(T1),30 minutes after nasal drops(T2),immediately after entry to the operating table(T3),and at the position of intraspinal anesthesia(T4).Hamilton Anxiety(HAM-A)score and Athens Insomnia Scale(AIS)score were recorded 1 day before surgery,1 day after surgery and 1 day after surgery.Adverse reactions and postoperative delirium(POD)were recorded one week after surgery.Results There were no significant differences in age,sex,body mass index(BMI),fracture type,anesthesia duration,operation time,blood loss and adverse reactions(except daytime sleepiness)among all groups(P>0.05).The VAS scores of T2,T3 and T4 in the combination group were significantly lower than those in the other two groups.HAM-A and AIS scores were significantly lower than those of the other two groups(P<0.05).The incidence and duration of postoperative delirium were significantly lower than those in the other two groups(P<0.05).Conclusion Prospective randomized controlled trials show that FICB combined with DEX can relieve pain,improve perioperative sleep quality and relieve postoperative delirium in patients with T

关 键 词：全髋关节置换术 髂筋膜间隙阻滞 右美托咪定 睡眠质量 术后谵妄 

分 类 号：R614[医药卫生—麻醉学]