髋关节囊阻滞与髂筋膜阻滞在老年髋关节置换术中的应用  

Application of hip capsule block and fascia iliaca block in elderly patients with hip replacement

作　　者：南洋[1] 张雪华[1] 王玲春[1] 朱纯纯[1] 张旭彤[1] 李军[1] NAN Yang;ZHANG Xuehua;WANG Lingchun;ZHU Chunchun;ZHANG Xutong;LI Jun(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University,Key Laboratory of Pediatric Anesthesiology of Ministry of Education,Zhejiang Key Laboratory of Anesthesiology,Wenzhou 325027,Zhejiang,China)

机构地区：[1]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,小儿麻醉学教育部重点实验室,浙江省麻醉学重点实验室,浙江温州325027

出　　处：《中国现代医生》2024年第36期17-21,共5页China Modern Doctor

基　　金：浙江省温州市基础性科研项目(Y20220949)。

摘　　要：目的评估超声引导下髋关节囊阻滞与髂筋膜阻滞在老年髋关节置换术中的镇痛效果及对术后康复的影响。方法选取2023年5月至12月在温州医科大学附属第二医院接受全髋关节置换术患者44例,按随机数字表法分为髂筋膜阻滞组(F组)和髋关节囊阻滞组(H组),每组22例。所有患者均采用腰麻联合神经阻滞麻醉。主要指标包括术后8h、24h、48h下肢肌力恢复情况及各观察点静止和运动视觉模拟量表(visual analogue scale,VAS)评分。次要指标为镇痛泵舒芬太尼消耗量、按压次数、病房额外帕瑞昔布钠使用率、住院时间及不良反应发生情况。结果H组患者术后8h、24h下肢肌力恢复优于F组,差异有统计学意义(P<0.05)。H组患者阻滞后30min及术后4h的静息和运动VAS评分均低于F组(P<0.05),而在其他时间点两组的静息和运动VAS评分差异均无统计学意义(P>0.05)。两组患者在阻滞后各时间点的静息和运动VAS评分均低于阻滞前(P<0.05)。H组患者术后4h镇痛泵舒芬太尼消耗量及按压次数均低于F组(P<0.05),之后各时间点两组的镇痛泵数据及帕瑞昔布钠使用率比较差异无统计学意义(P>0.05)。两组患者术后48h内恶心发生率及住院时间比较差异无统计学意义(P>0.05)。结论髂筋膜阻滞和髋关节囊阻滞均可安全有效应用于老年髋关节置换术,但髋关节囊阻滞镇痛作用起效更快、术后早期镇痛效果更佳,对下肢运动影响更小。Objective To evaluate the analgesic effects of ultrasound-guided hip capsule block and fascia iliaca block in elderly patients undergoing hip replacement surgery and their impacts on postoperative rehabilitation.Methods A total of 44 patients who underwent total hip replacement in the Second Affiliated Hospital of Wenzhou Medical University from May to December in 2023 were selected and divided into fascia iliaca block group(group F)and hip capsule block group(group H)according to the random number table,with 22 cases in each group.All patients were anesthetized by lumbar anesthesia combined with nerve block.The primary indicators included the recovery of lower limb muscle strength at 8h,24h,48h after operation and the rest and movement visual analogue scale(VAS)scores at each observation point.The secondary indicators were sufentanil consumption of analgesic pump,the number of compressions,the use rates of additional parecoxib sodium in ward,the length of hospital stay and the occurrence of adverse reactions.Results The recovery of lower limb muscle strength in group H was better than that in group F at 8h and 24h after operation,and the difference was statistically significant(P<0.05).The rest and movement VAS scores at 30min after block and 4h after operation in group H were significantly lower than those in group F(P<0.05),while there were no significant differences in the rest and movement VAS scores between two groups at other time points(P>0.05).The rest and movement VAS scores at each time point after blockade were lower than those before blockade in two groups(P<0.05).The sufentanil consumption in analgesic pump and the number of compressions in group H was lower than that in group F at 4h after operation(P<0.05),and there were no significant differences in analgesic pump data and the use rates of parecoxib sodium between two groups at subsequent time points(P>0.05).There were no statistically significant difference in the incidence of nausea within 48h after operation and hospital stay between two group

关 键 词：髋关节置换术 腰麻 镇痛 罗哌卡因 髋关节囊阻滞 髂筋膜阻滞 

分 类 号：R614[医药卫生—麻醉学]