髋关节囊周神经阻滞联合仰卧位冠状入路行前路腰方肌阻滞在老年髋部骨折手术中的应用  

Pericapsular nerve group block in combination with the supine coronal approach to anterior quadratus lumborum block for hip fracture surgery in elderly patients

作　　者：徐贤根 汪海丹 林向阳 李臣臣 黄炳武 李挺[2] XU Xian’gen;WANG Haidan;LIN Xiangyang;LI Chenchen;HUANG Bingwu;LI Ting(Department of Anesthesiology,Cangnan Affiliated Hospital of Wenzhou Medical University,Wenzhou 325800,China;Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属苍南医院麻醉科,浙江温州325800 [2]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,浙江温州325027

出　　处：《温州医科大学学报》2024年第10期828-832,838,共6页Journal of Wenzhou Medical University

基　　金：温州市基础性科研项目(Y2023971)。

摘　　要：目的:评价超声引导下髋关节囊周神经阻滞(PENG)联合仰卧位冠状入路行前路腰方肌阻滞(SCAQLB)应用于老年髋部骨折手术围术期的镇痛效果。方法:选择2023年1月至2023年12月在温州医科大学附属苍南医院行髋部骨折手术老年患者80例,所有患者椎管内麻醉摆放侧卧位前,在超声引导下进行神经阻滞,采用随机数字表法分为PENG联合SCAQLB组(PS组)和髂筋膜间隙阻滞(FICB)组(F组),每组40例。记录通过患者自控静脉镇痛(PCIA)的术后24 h内舒芬太尼累积消耗量和首次按压时间。记录患者入室时(T0)和神经阻滞后30 min(T1)以及术后6 h(T2)、12 h(T3)、24 h(T4)的VAS评分。记录椎管内麻醉定位难易度(EOSP)评分、患者满意度评分以及股四头肌无力等相关不良反应。结果:PS组术后24 h内舒芬太尼累积消耗量低于F组(P<0.001)。PS组术后首次PCIA按压时间较F组明显推迟(P<0.001)。PS组T1-T4静息和活动VAS评分均低于F组(P<0.05)。PS组患者满意率明显高于F组(P<0.05)。PS组摆放侧卧位时补救镇痛率低于F组(P<0.05),PS组麻醉医师对体位摆放满意率高于F组(P<0.05)。PS组无一例发生股四头肌无力,而F组有9例发生。结论:PENG联合SCAQLB优于传统的FICB,对老年髋部骨折手术患者椎管内麻醉摆放侧卧位及术后都有良好的镇痛效果,且不削弱股四头肌肌力,提高患者满意度。Objective:To evaluate the perioperative analgesic effect of pericapsular nerve group(PENG)block in combination with the supine coronal approach to anterior quadratus lumborum block(SCAQLB)for hip fracture surgery in elderly patients.Methods:A total of 80 elderly patients undergoing hip fracture surgery in Cangnan Hospital Affiliated to Wenzhou Medical University from January 2023 to December 2023 were selected,who were randomly divided into 2 groups(n=40 each)using a random number table:PENG in combination with SCAQLB(group PS)and fascia iliaca compartment block(FICB)group(group F).All patients underwent nerve block for analgesia guided under ultrasound before changes of position for combined spinal-epidural anesthesia.The cumulative consumption of sufentanil and the time to first compression within 24 hours after surgery through patient-controlled intravenous analgesia(PCIA)were recorded.The visual analogue scale(VAS)scores at rest and during movement were recorded when patients entering the operation room(T0),30 min after nerve block(T1),6 h(T2),12 h(T3)and 24 h(T4)after surgery.Ease of spinal anesthesia positioning,rate of rescue analgesia at the time of the position changing,patient’s satisfaction score and complications such as quadriceps weakness were also recorded.Results:The cumulative consumption of sufentanil in group PS was lower than that in group F(P<0.001).Time to first PCIA request was prolonged significantly in group PS than that in group F(P<0.001).VAS scores at rest and during movement in group PS were lower than those in group F at T1 to T4(P<0.05).The satisfaction rate of patients was significantly higher in group PS than in group F(P<0.05).The rate of rescue analgesia at the time of the position changing was lower in group PS than in group F(P<0.05).The satisfaction rate of anesthesiologists with body position in group PS was higher than in group F(P<0.05).No case of quadriceps weakness occurred in group PS,whereas 9 cases occurred in group F.Conclusion:PENG in combination with SCAQLB is su

关 键 词：髋关节囊周神经阻滞 腰方肌阻滞 超声引导 髋部骨折手术 镇痛 

分 类 号：R614.4[医药卫生—麻醉学]