摘要
目的探讨术前行超声引导下髂筋膜间隙阻滞在老年患者全髋关节置换术中的应用效果。方法回顾性分析择期在全身麻醉下行全髋关节置换术的老年患者98例,男40例,女58例,年龄≥65岁,BMI 16~28 kg/m^(2),ASAⅡ或Ⅲ级。根据术前是否行髂筋膜间隙阻滞分为两组:髂筋膜间隙阻滞组(F组,n=43)和对照组(C组,n=55)。根据性别、年龄、BMI、ASA分级、基础疾病、手术方式进行倾向评分匹配。收集手术时间、麻醉时间、术中出血量、术中舒芬太尼和瑞芬太尼用量、术后2、6、12、24、48 h静息和活动时NRS评分、首次下床活动时间、住院时间、术后48 h镇痛满意度评分、术后48 h内患者自控静脉镇痛(PCIA)有效按压次数以及术后48 h内PCIA舒芬太尼用量。记录术后输血、入ICU以及相关不良反应(包括肺部感染、尿路感染、心律失常、术后恶心呕吐、尿潴留、瘙痒、呼吸抑制、嗜睡)的发生情况。结果匹配后F组和C组各纳入患者43例。F组术中舒芬太尼和瑞芬太尼用量明显少于C组(P<0.05)。F组术后2、6 h静息时NRS评分以及术后2、6、12、24、48 h活动时NRS评分明显低于C组(P<0.05)。F组首次下床活动时间、住院时间明显短于C组(P<0.05),F组术后48 h镇痛满意度评分明显高于C组(P<0.05),F组术后48 h内PCIA有效按压次数以及PCIA舒芬太尼用量明显少于C组(P<0.05)。F组术后恶心呕吐及尿潴留的发生率明显低于C组(P<0.05)。两组手术时间、麻醉时间、术中出血量、术后12、24、48 h静息时NRS评分、术后输血、入ICU以及肺部感染、尿路感染、心律失常、术后瘙痒、嗜睡发生率差异均无统计学意义。结论术前行超声引导下髂筋膜间隙阻滞能为老年患者全髋关节置换术后提供良好镇痛,减少镇痛药物的使用,提高镇痛满意度,同时促进患者术后早期恢复。
Objective To investigate application of ultrasound-guided fascia iliaca compartment block in elderly patients undergoing total hip arthroplasty.Methods The relevant information of 98 patients,40 males and 58 females,aged≥65 years,BMI 16-28 kg/m^(2),ASA physical statusⅡorⅢ,underwent elective general anesthesia for total hip arthroplasty were retrospectively analyzed.The patients were divided into two groups according to whether fascia iliaca compartment block was performed before surgery:ultrasound-guided fascia iliaca compartment block group(group F,n=43)and control group(group C,n=55).A propensity score matching analysis was performed according to gender,age,BMI,ASA physical status,underlying disease and surgical method.Duration of surgery,duration of anesthesia,intraoperative blood loss,intraoperative dosage of sufentanil and remifentanil,NRS scores at rest and in activity 2,6,12,24,48 hours after surgery were recorded.The time of first getting out of bed,hospitalization time,48 hours after surgery satisfaction score of analgesia,the number of effective pressing within 48 hours after surgery of patient-controlled intravenous analgesia(PCIA)and the dosage of sufentanil within 48 hours after surgery in PCIA were recorded.Postoperative transfusion,postoperative admission to ICU,the postoperative incidence of pulmonary infection,urinary tract infection and arrhythmia,nausea and vomiting,urinary retention,pruritus,respiratory depression and hypersomnia were also recorded.Results After matching,group F and group C included 43 patients respectively.The intraoperative dosage of sufentanil and remifentanil in group F were significantly lower than those in group C(P<0.05).The NRS scores at rest 2 and 6 hours after surgery and in activity 2,6,12,24,48 hours after surgery in group F were significantly lower than those in group C(P<0.05).The time of first getting out of bed and hospitalization time in group F were significantly shorter than those in group C(P<0.05).The 48 hours after surgery satisfaction score of analgesia in group F was significantly higher than that in group C(P<0.05).The number of effective pressing for 48 hours after surgery of PCIA and the dosage of sufentanil 48 hours after surgery in PCIA in group F were significantly less than those in group C(P<0.05).The incidence of postoperative nausea and vomiting and urinary retention in group F were significantly lower than those in group C(P<0.05).There were no significant differences in operation duration,anesthesia duration and intraoperative blood loss between the two groups.There were also no significant differences in NRS score at rest 12,24,48 hours after surgery.There were no significant differences in postoperative transfusion,postoperative admission to ICU,pulmonary infection,urinary tract infection and arrhythmia,postoperative pruritus,and hypersomnia between the two groups.Conclusion Ultrasonic-guided fascia iliaca compartment block before surgery can provide satisfactory analgesia for elderly patients undergoing total hip arthroplasty,reduce the use of analgesics,improve the satisfaction of analgesia and promote early postoperative recovery of patients.
作者
刘绪华
谢珏
袁从旺
芮云峰
孙杰
LIU Xuhua;XIE Jue;YUAN Congwang;RUI Yunfeng;SUN Jie(Department of Anesthesiology,Zhongda Hospital,Southeast University,Nanjing 210009,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2022年第4期356-360,共5页
Journal of Clinical Anesthesiology
关键词
髋关节置换术
髂筋膜间隙阻滞
镇痛
倾向评分匹配
老年
Total hip arthroplasty
Fascia iliaca compartment block
Analgesia
Propensity score matching
Aged
