应用自动间断冲击量给药方式进行连续髂筋膜间隙阻滞的临床研究

A clinical study of the efficacy of automated intermittent boluses for continuous fascia iliaca block

目的对比超声引导连续髂筋膜间隙阻滞两种给药方案对全髋关节置换术后镇痛效果的影响。方法经北京大学第三医院伦理委员会批准，选择2015年5月至2016年3月于北京大学第三医院行择期单侧全髋关节置换术的患者60例，椎管内麻醉前行超声引导连续髂筋膜间隙阻滞。采用随机数字表法将患者随机分为恒速输注组（／7,=30）与自动间断冲击量给药组（n=30）。恒速输注组采用0．2％罗哌卡因10ml／h恒速输注，自动间断冲击量给药组采用0．2％罗哌卡因自动给药10ml，间隔时间60rain。2组均持续输注48h。应用数字疼痛评分法（NRPS）评估阻滞后4、8、12、24、36、48h患者静息状态及功能锻炼时的疼痛程度，同时比较2组患者的术后杜冷丁使用率、阿片类药物相关不良反应发生率及48h患者满意度评分。结果自动间断冲击量给药组阻滞后8、12、24、36h静息疼痛评分分别为2（1—3）、2（1～3）、2（1—3）、2（1～3）分，低于恒速输注组的4（2～6）、3（2—5）、4（3～5）、2（1—4）分，差异有统计学意义（Z=-6．493、-6．267、-6．235、-3．244，均P〈0．05）。自动间断冲击量给药组阻滞后8、12、24、36h动态疼痛评分分别为4（3—5）、4（3～5）、2（1～3）、1（0—3）分，低于恒速输注组的6（4—7）、5（4—7）、4（2—6）、4（2—5）分，差异有统计学意义（Z=-6．499、-6．499、-5．081、-6．667，均P〈0．05）。自动间断冲击量给药组术后杜冷丁使用率及阿片类药物不良反应发生率分别为10．0％和3．3％，低于恒速输注组的33．3％和26．7％，差异有统计学意义（x2=5．057、4．500，均P〈0．05）。自动间断冲击量给药组48h患者满意度评分为（8．3±0．7）分，高于恒速输注组的（7．4±0．7）分，差异有统计学意义（t=-5．632，P〈0．05）。结论两种给药方案均能为全髋置换术后提供有效镇痛，但与恒速输注组相比，自动间断冲击量给药组镇痛效果高于恒速输注组，术后补救镇痛用药明显减少。

Objective To compare two different regimens of continuous ultrasound-guided fascia iliaca compartment block （FICB） for postoperative analgesia after total hip arthroplasty （THA）. Methods Approved by the Peking University Third Hospital ethics committee, sixty patients undergoing selective single total hip replacement in Peking University Third Hospital from May. 2015 to Mar. 2016 were included. Before neuraxial block, continuous ultrasound-guided FICB were administered. Patients were randomly divided into the continuous infusion group （ n = 30） and the automated intermittent boluses group （ n = 30）. 10 ml/h of O. 2% ropivacaine was continuously infused for 48 hours in the continuous infusion group. 10 ml of 0. 2% ropivacaine was automated injected every 60 rains in the automated intermittent boluses group. Numerical Rating Pain Scale（NRPS）was used to assess pain intensity at 4, 8, 12, 24, 36,48 h after block at rest and during functional exercise. The usage of pethidine postoperatively, the incidence of opioid related adverse effect and patient satisfaction scores at 48 h were also recorded. Results The pain score at rest 8, 12, 24, 36 h of the automated intermittent boluses group were 2 （ 1 - 3 ）, 2 （ 1 - 3 ）, 2 （ 1 - 3 ）, 2 （ 1 - 3 ） score, which were lower than the continuous infusion group ： 4 （2 - 6）, 3 （2 - 5）, 4 （3 - 5 ）, 2 （ 1 - 4） score, the differences were statistically significant （Z = - 6. 493, - 6. 267, - 6. 235, - 3. 244, all P 〈 0. 05）. The pain score during active and passive functional exercise at 8, 12, 24, 36 h of the automated intermittent boluses group were4 （3 -5）, 4 （3 -5）, 2 （1 -3）, 1（0 -3） seore, which were lower than the continuous infusion group： 6 （4-7）, 5 （4-7）, 4 （2-6）, 4 （2-5） sere＇e, the differences were statistically significant （ Z = - 6. 499, - 6. 499, - 5.081, - 6. 667, all P 〈 0. 05 ）. The usage of pethidine postoperatively and the incidence of opioid related adverse effect of the automated intermittent boluses group were 10. 0% and 3.3% ,whieh were lower than the continuous infitsioo group： 33.3% and 26. 7% , the differences were statistically significant （ X2 = 5. 057, 4. 500, all P 〈 O. 05 ）. Patient satisfaction score at 48 h of the automated intermittent boluses group was （ 8.3 ± 0. 7 ） score, which was higher than the continuous infusion group ： （7.4 ± 0. 7 ） score, the difference was statistically significant （ t =- 5. 632, P 〈 0. 05 ） . Conclusions Both regimens can provide effective analgesia alter total hip arthroplasty. Compared with the continuous infusion group, the automated intermittent boluses group for eontinuous faseia iliaea block can provide better analgesic effect ,with less remedial analgesia.