超声引导髂筋膜间隙阻滞在老年患者全髋关节置换术中的应用

Efficacy of ultrasound-guided fascia iliaca compartment block in elderly patients undergoing total hip replacement surgery

目的观察超声引导下单次髂筋膜间隙阻滞对老年患者全髋关节置换术术中血流动力学及术后镇痛的影响。方法选择行择期全麻下全髋关节置换术的老年患者48例,随机分为髂筋膜间隙阻滞组(Y组,n=24)和未行髂筋膜间隙阻滞组(N组,n=24)。Y组于术前15 min行0.4%罗哌卡因髂筋膜间隙注射。2组于手术结束前10 min开始采用2μg/kg的舒芬太尼行经静脉患者自控镇痛(PCA),N组予背景剂量2 ml/h,Y组予背景剂量0,2组均为PCA 2 ml,锁定时间5 min,最大剂量5μg/h。Y组自第1次PCA后改背景剂量至2ml/h。记录切皮时至切皮后3 min内、拔管时至拔管后3 min内收缩压(SBP)>140 mm Hg,心率(HR)>90次/min的例数,进行术后6、12、24 h静态疼痛视觉模拟评分(VAS),记录术后PCA按压次数及2组患者恶心呕吐的发生率。结果 Y组患者切皮时至切皮后3 min内SBP>140 mm Hg,HR>90次/min的例数明显少于N组(P<0.05);术中舒芬太尼的追加量明显小于N组(P<0.05);术后6、12 h评估静态VAS评分低于N组(P<0.05);术后PCA的按压次数低于N组(P<0.05);术后恶心呕吐发生率低于N组(P<0.05)。结论超声引导下单次髂筋膜间隙阻滞能明显降低老年全髋关节置换术患者术中及术后阿片类药物的使用量,且术中血流动力学平稳,术后镇痛效果好,不良反应少。

Objective To observe the efficacy of ultrasound-guided fascia iliaca compartment block on pain control during or after total hip replacement surgery in the elderly patients. Methods Forty-eight elderly patients（ ASAⅠ-Ⅱ） undergoing total hip replacement surgery with general anesthesia were selected. They were randomly divided into two groups with 24 patients in each group. The patients receiving fascia iliaca block were enrolled in group Y and the patients not receiving fascia iliaca block were enrolled in group N. Ropivacaine 0. 4 % was injected into fascia iliaca compartment guided by ultrasound 15 minutes before the surgery in group Y. Ten minutes before the end of operation,all patients of two groups received patient controlled analgesia（ PCA） by intravenous infusion of sucfentanil2 μg / kg,with a base dose of 2 ml / h in group N and 0 in group Y. Locked time was 5 min,and maximal dose was 5μg /h in the two groups. The number of the patients with SBP 140 mm Hg and HR 90 bpm during the period from skin incision to 3 min after incision and from tube drawing to 3 min after tube drawing,the dosage of sulfentanil during the operation,the VAS scores at the time of 6,12,24 h after operation at rest,the frequency of pressing the PCA button after the operation and the incidence of nausea and vomiting were recorded. Results Compared with group N,the numbers of the patients with SBP 140 mm Hg and HR 90 bpm were obviously reduced in group Y（ P〈0. 05）.The VAS scores in group Y was lower than that of group N at the time of 6,12 h after operation（ P〈0. 05）. The frequency of pressing the PCA button in group Y was lower than that in group N（ P〈0. 05）. The incidence rate of nausea and vomiting in group Y was lower than that in group N（ P〈0. 05）. Conclusions The ultrasound-guided fascia iliaca compartment block can obviously reduce the dosage of sulfentanil during and after the operation and maintain the stability of hemodynamics during the operation for the elderly patients. It has effective analgesia after the operation and seldom adverse reaction.