超声引导下髂筋膜间隙阻滞对全麻下老年全髋关节置换患者术中应激水平及术后疼痛程度的影响

Effects of ultrasound-guided fascia iliaca compartment block on stress level and postoperative analgesia of the elderly patients undergoing total hip arthroplasty with general anesthesia

目的观察超声引导下髂筋膜间隙阻滞对全麻下老年全髋关节置换患者术中应激水平及术后疼痛程度的影响。方法选取40例ASAⅠ~Ⅱ级、年龄65~80岁全髋关节置换术患者,随机分为观察组和对照组,每组20例。2组患者均给予常规全麻诱导,观察组于诱导后行超声引导下髂筋膜间隙阻滞麻醉。分别记录2组患者入室时(T0)、切皮(T1)、扩髓腔(T2)和术毕时(T3)平均动脉压(MAP)和心率(HR);抽取肘静脉血测定2组T0~T3时皮质醇(Cor);记录2组T3、术后4 h(T4)、术后8 h(T5)疼痛视觉模拟评分(VAS)。结果 T1~T3时间点,观察组MAP、HR、Cor水平均低于对照组(P<0.05);T3~T5时间点,观察组VAS评分低于对照组。结论超声引导下髂筋膜间隙阻滞应用于全麻下老年全髋关节置换术患者,有利于降低术中的应激水平,维持血流动力学的平稳,减轻术后疼痛。

Objective To observe the effects of ultrasound-guided fascia iliaca compartment block on stress level and postoperative analgesia of the elderly patients undergoing total hip arthroplasty with general anesthesia. Methods Forty patients who were of ASA, were classified I - II, age 65 - 80 and have received total hip arthroplasty surgery, were randomly di- vided into two groups： observation group and control group with each group included 20 cases. All the patients of the two groups were received normal anesthesia induction. The patients of the observation group were received ultrasound-guided fascia iliaca compartment block after induction. The mean arterial pressure （MAP） and heart rate （HR） were recorded at the mo- ment of arriving the operation room （ T0）, the moment of skin incision （ T1 ）, the moment of reaming （T2） and the end of surgery （33）. Extraction 2 groups of elbow venous blood to measure cortisol （Cor） at T0 - T3. The score of Visual Analogue Scale （VAS） were recorded at 33,4 hours after operation （T4） ,8 hours after operation（ T5 ）. Results At T1 -3, the MAP, HR and Cor in observation group were significantly lower than that in control group （ P 〈 O. 05 ）. At 33 - 5, the score of VAS in observation group were significantly lower than that in control group. Conclusions Ultrasound-guided fascia iliaea compart- ment block applied on the elderly patients undergoing total hip arthroplasty with general anesthesia can help relieving the stress reaction, keeping the balance of the hemodynamics, and also can help relieving postoperative pain.