不同浓度罗哌卡因髂筋膜间隙阻滞用于高龄患者半髋置换术麻醉效果的比较

Comparison of anesthetic effects of fascia iliaca compartment block with different concentrations of ropivacaine in elderly patients undergoing hemiarthroplasty

目的评估比较不同浓度罗哌卡因髂筋膜间隙阻滞在高龄患者股骨颈骨折行半髋置换术中的麻醉效果和安全性。方法选取股骨颈骨折拟行半髋置换术高龄患者90例,按罗哌卡因髂筋膜间隙阻滞的给药浓度分为3组:L组(0.3%组)、M组(0.4%组)和H组(0.5%组)。观察患者髂筋膜间隙阻滞前后的心率和动脉压变化,评价阻滞效果,评估术前和术后2、6、12、24h和48h静息和运动视觉模拟评分法(VAS)评分,观察不良反应。结果 3组患者切皮前后血流动力学稳定,术后2、6、12h静息VAS评分明显低于术前,术后24h仅H组低于术前;术后运动VAS评分均低于术前(P<0.05)。M组和H组的VAS评分相似,明显低于L组。L组术后舒芬太尼用药量最大,嗜睡和呕吐的发生率最高(P<0.05)。结论罗哌卡因髂筋膜间隙阻滞麻醉可安全用于高龄患者,提供有效的半髋置换术后早期镇痛。0.4%组和0.5%组罗哌卡因镇痛效果优于0.3%组;0.5%罗哌卡因组的有效镇痛时间更长,但0.4%罗哌卡因组的满意度更高。

Objective To evaluate the efficacy and safety of fascia iliaca compartment block with different concentrations of ropivacaine in elderly patients undergoing hemiarthroplasty for femoral neck fracture.MethodsNinety elderly patients who underwent hemiarthroplasty for femoral neck fracture were selected and allocated randomly into 3 groups（n=30）：group L（group 0.3%）,group M（group 0.4%）and group H（group 0.5%）.The changes of HR and BP before and after fascia iliac space block were observed in three groups,and the block effect was evaluated.Static and dynamic VAS scores of pre-operation and post-operation（3 h,6 h,12 h,24 hand48 h）were evaluated while adverse reactions were recorded.Results The hemodynamics in each groups had no difference between before and after skin incision.Static VAS scores of 3 h,6 hand 12 hwere significantly lower than that of pre-operation.They were also lower in the H group after 24 h.Dynamic VAS scores of all three groups were lower than those of pre-operation（P 〈0.05）.The VAS scores of group M and group H were similar,which were significantly lower than those of group L.The amount of Sulfentanyl required in group L was highest,also the incidence of somnolence and vomiting in group L was highest（P 〈0.05）.Conclusion Ropivacaine fascia iliaca compartment block can be safely used in elderly patients and provide effective early postoperative analgesia for hemiarthroplasty.The analgesic effect of 0.4% and 0.5% ropivacaine was better than 0.3%.The0.5% ropivacaine had longer analgesia duration,but 0.4% ropivacaine group had higher satisfaction.