术前髂筋膜间隙阻滞对老年髋部骨折合并脆弱心脏功能患者术后转归的影响  

Effect of preoperative fascia iliaca compartment block on postoperative outcomes of elderly patients with hip fracture and fragile heart function

作　　者：李霞 周振东 刘瑞娟 许梦君 阎文军[1] LI Xia;ZHOU Zhendong;LIU Ruijuan;XU Mengjun;YAN Wenjun(Department of Anesthesiology,Gansu Provincial Hospital,Lanzhou 730000;Qingdao Haici Medical Group,Qingdao 266000,China)

机构地区：[1]甘肃省人民医院麻醉科,甘肃兰州730000 [2]青岛市海慈医疗集团,山东青岛266000

出　　处：《麻醉安全与质控》2024年第6期304-308,共5页Perioperative Safety and Quality Assurance

基　　金：甘肃省自然科学基金(21JR7RA621);甘肃省重点研发计划(23YFFA0046);临床医学研究中心建设(21JR7RA675);兰州市科技局医疗卫生专项(2023-1-47)。

摘　　要：目的观察术前使用连续髂筋膜间隙阻滞(FICB)镇痛对老年髋部骨折并伴有脆弱心脏功能的患者在术后转归的影响。方法选取甘肃省人民医院2022-01/2023-07期间接受手术治疗的老年髋部骨折合并脆弱心脏功能患者200例,年龄65~88岁,其中男82例,女118例,ASA分级Ⅱ或Ⅲ级,纽约心脏病协会(NYHA)心功能分级Ⅱ或Ⅲ级,采用随机数字表法将患者分为对照组(C组,n=100)和术前髂筋膜间隙阻滞组(F组,n=100)。C组患者入院后2 h内静脉注射氟比洛芬酯注射液50 mg,F组给予连续髂筋膜间隙阻滞,观察患者总住院时间、首次下床时间、匹兹堡睡眠质量指数(PSQI)评分和简易精神状态评价量表(MMSE)评分、视觉模拟评分法(VAS)、术后并发症、半年内死亡率。结果与C组比较,F组在早期下床的时间、总住院时间以及PSQI评分明显减少,差异具有统计学意义(P<0.05)。与C组比较,F组在术后的VAS评分明显下降,而MMSE评分有所上升,且F组呼吸系统与心血管的并发症、下肢静脉血栓、死亡率均明显降低,差异有统计学意义(P<0.05)。结论对老年髋部骨折并伴有脆弱心脏功能的患者,术前使用FICB可明显缩短住院时间,降低术后呼吸系统心血管并发症、下肢静脉血栓发生率,促进术后恢复。Objective To observe the effect of preoperative continuous high fascia iliaca compartment block(FICB)on the postoperative outcomes of elderly patients with hip fracture and fragile heart function.Methods A total of 200 patients with hip fracture and fragile cardiac function,including 82 males and 118 females,aged 65-88 years,ASAⅡorⅢ,NYHA heart classificationⅡorⅢ,from January 2022 to July 2023 in Gansu Provincial Hospital were selected and randomly divided into control group(group C,n=100)and preoperative fascia iliaca compartment block group(group F,n=100).The patients in group C were intravenously injected with flurbiprofen axetil 50 mg,within 2 h after admission.The patients in group F were given continuous fascia iliaca compartment block.The total length of hospital stay,first time out of bed,PSQI score,MMSE score,VAS pain score,postoperative complications and mortality within half a year were observed.Results Compared with group C,the time of getting out of bed,total hospital stay and PSQI score in group F were significantly reduced,and the difference was statistically significant(P<0.05).Compared with group C,the VAS score in group F was significantly decreased,while the MMSE score was increased,and the respiratory and cardiovascular complications,lower extremity venous thrombosis and mortality in group F were significantly reduced,with statistically significant differences(P<0.05).Conclusion For elderly patients with hip fracture and fragile heart function,preoperative continuous FICB can significantly shorten the length of hospital stay,reduce the incidence of postoperative respiratory cardiovascular complications and lower extremity venous thrombosis,and promote postoperative recovery.

关 键 词：老年髋部骨折 脆弱心功能 围术期转归 

分 类 号：R614[医药卫生—麻醉学]