超声引导下髂筋膜神经阻滞复合椎管内麻醉对全髋关节置换手术患者血流动力学及手术应激的影响  

Effect of ultrasound-guided fascia iliaca compartment block combined with spinal anesthesia on hemodynamics and surgical stress in patients undergoing total hip arthroplasty

作　　者：孙伟一 闫小强 贺伟忠 Sun Weiyi;Yan Xiaoqiang;He Weizhong(Department of Anesthesiology,Kaifeng Central Hospital,Kaifeng 475000,China)

机构地区：[1]开封市中心医院麻醉科,开封475000

出　　处：《中国实用医刊》2025年第4期52-55,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨超声引导下髂筋膜神经阻滞(FICB)复合椎管内麻醉在全髋关节置换手术(THA)中的应用效果。方法队列研究。抽取2021年8月至2024年11月开封市中心医院收治的THA患者66例,按随机数字表法分为对照组和观察组,每组33例。对照组行椎管内麻醉,观察组加用FICB。比较两组血流动力血指标[平均动脉压(MAP)、心率(HR)]、手术应激指标[皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)]、术后疼痛[视觉模拟评分法(VAS)]评分、术后情况(术后镇痛泵首次按压时间、48 h内有效按压次数、首次下床活动时间)及不良反应。结果手术切皮及骨膜剥离时,观察组MAP、HR水平均低于对照组(P均<0.05)。术后,观察组NE、COR、ACTH水平均低于对照组(P均<0.05)。术后6、12、24 h,观察组VAS评分均低于对照组(P均<0.05)。观察组术后镇痛泵首次按压时间[(290.51±30.57)min]长于对照组[(221.44±28.67)min],首次下床活动时间[(3.25±0.39)]短于对照组[(4.47±0.49)d],48 h内有效按压次数[(8.61±1.15)次]少于对照组[(12.87±1.32)次],P<0.05。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论FICB复合椎管内麻醉可减轻THA患者手术应激反应,减小术中血流动力学波动,减轻术后疼痛,安全可行。ObjectiveTo investigate the effect of ultrasound-guided fascia iliaca compartment block(FICB)combined with spinal anesthesia in patients undergoing total hip arthroplasty(THA).MethodsSixty-six THA patients admitted to Kaifeng Central Hospital from August 2021 to November 2024 were selected for the cohort study.And they were divided into the control group and the observation group using a random number table method,with 33 cases in each group.The control group received spinal anesthesia,while the observation group received FICB combined with spinal anesthesia.The hemodynamic blood indicators including mean arterial pressure(MAP)and heart rate(HR),surgical stress indicators including cortisol(Cor),norepinephrine(NE)and adrenocorticotropic hormone(ACTH),postoperative pain assessed by visual analogue scale(VAS)score,postoperative conditions(first press time of postoperative analgesia pump,effective compression frequency within 48 hours,first time of ambulation),and adverse reactions of the two groups were compared.ResultsDuring surgical skin cutting and periosteal peeling,the levels of MAP and HR in the observation group were lower than those in the control group(all P<0.05).After surgery,the levels of NE,Cor,and ACTH in the observation group were lower than those in the control group(all P<0.05).At 6,12,and 24 hours postoperatively,the VAS scores of the observation group were lower than those of the control group(all P<0.05).The first press time of the postoperative analgesia pump in the observation group was(290.51±30.57)min,longer than the(221.44±28.67)min in the control group(P<0.05).The first time of ambulation in the observation group was(3.25±0.39)d,shorter than the(4.47±0.49)d in the control group(P<0.05).The effective compression frequency within 48 hours in the observation group was(8.61±1.15)times,which was less than the(12.87±1.32)times in the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).ConclusionsApplic

关 键 词：髋关节置换术 椎管内麻醉 髂筋膜神经阻滞 超声引导 血流动力学 

分 类 号：R614[医药卫生—麻醉学]