竖脊肌平面阻滞与髂筋膜间隙阻滞用于髋关节置换术的镇痛效果对比  

Comparison of analgesic effects of erector spinae plane block and fasciailiaca compartment block for hip replacement

作　　者：江伟[1] 郑霞[1] 杨柳[1] 税春玲[1] JIANG Wei;ZHENG Xia;YANG Liu;SHUI Chunling(Department of Anesthesiology,The Affiliated Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院麻醉科,重庆402160

出　　处：《麻醉安全与质控》2025年第2期103-107,共5页Perioperative Safety and Quality Assurance

基　　金：重庆市卫生健康委2023年重庆市医学科研项目(2023WSJK102)。

摘　　要：目的探讨腰部竖脊肌平面阻滞(ESPB)在髋关节置换术后镇痛中的效果。方法选取2023年1~12月重庆医科大学附属永川医院行髋关节置换术的患者60例,年龄60~80岁,ASA分级Ⅰ~Ⅲ级,BMI 16.0~26.0 kg/m 2,采用随机数字表法将患者分为对照组(n=30)和观察组(n=30)。两组均行单侧腰麻,术后观察组行ESPB,对照组行髂筋膜间隙组滞(FICB);两组术后均给予标准配置的自控静脉镇痛泵。对两组患者术后4、8、12、24、48 h视觉模拟评分法(VAS)和术后镇痛情况进行记录;分别于术后24 h和48 h,记录两组患者股四头肌徒手肌力分级(MMT)评分;记录两组患者术后恢复情况。结果两组术后4、8、12、24、48 h各时间点VAS评分(静息、活动)及术后48 h内镇痛泵按压次数、补救镇痛率对比,差异均无统计学意义(P>0.05)。与对照组比较,观察组术后24 h和48 h MMT评分明显增高,差异有统计学意义(P<0.05)。观察组首次下床活动的时间较对照组明显提前,术后住院时间也较对照组进一步缩短,差异有统计学意义(P<0.05)。结论ESPB用于髋关节置换术后镇痛的效果与FICB相当,且在发挥镇痛的同时,对患者术后下肢肌力影响小,利于早期下床。Objective To explore the efficacy of erector spinae plane block(ESPB)in postoperative analgesia after hip replacement surgery.Methods A total of 60 patients,aged 60-80 years,ASAⅠ-Ⅲ,BMI 16.0-26.0 kg/m 2,undergoing hip replacement at the Affiliated Yongchuan Hospital of Chongqing Medical University,from January to December 2023 were randomly divided into control group(n=30)and observation group(n=30)using a random number table method.Both groups underwent unilateral spinal anesthesia.After surgery,the observation group underwent ESPB and the control group underwent fascia iliaca compartment block(FICB);both groups were given standard configured patient-controlled intravenous analgesia pumps after surgery.The visual analogue scale(VAS)and postoperative analgesia of the two groups were recorded at 4,8,12,24,48 h after operation.At 24 h and 48 h after operation,the manual muscle strength grading(MMT)scores of quadriceps femoris of both groups were recorded.The postoperative recovery of the two groups was recorded.Results There was no significant difference in VAS score(at rest or during activity)at 4,8,12,24 and 48 h after operation,patient controlled intravenous analgesia press times and the rate of remedial analgesia within 48 h after operation between the two groups(P>0.05).Compared with the control group,the MMT scores of the observation group were significantly higher at 24 h and 48 h after operation,and the difference was statistically significant(P<0.05).In terms of the first time of getting out of bed activity,the observation group was significantly earlier than the control group,and the difference was statistically significant(P<0.05),and the postoperative hospitalization time of the observation group was further shortened compared to the control group,with statistical significance(P<0.05).Conclusion The effect of ESPB on postoperative analgesia after hip replacement is comparable to that of FICB,and it has little effect on postoperative lower limb muscle strength while exerting analgesia,which is conduci

关 键 词：髋关节置换术 竖脊肌平面阻滞 髂筋膜间隙阻滞 镇痛 下肢肌力 

分 类 号：R47[医药卫生—护理学]