超声引导下髂筋膜间隙阻滞复合浅全麻在老年髋关节置换术中的应用

Application of ultrasound-guided fascia iliaca compartment block combined with superficial general anesthesia in hip arthroplasty in elderly patients

目的探讨超声引导下髂筋膜间隙阻滞(fascia iliaca compartment block,FICB)复合浅全麻在老年患者髋关节置换术中的麻醉效果及对术后恢复的影响。方法选择2018年6月—2019年6月本院收治的全麻下行择期髋关节置换术的老年患者60例作为研究对象,年龄65~102岁,ASAⅡ~Ⅲ级。随机分为神经阻滞复合浅全麻组(F组)和单纯全麻组(C组)两组,每组各30例。两组患者均在全身麻醉下完成手术,F组术前于超声引导下行髂筋膜间隙阻滞,C组不作任何处理。记录两组患者入室(T 0)、摆体位(T 1)、切皮后5 min(T 2)、扩髓腔(T 3)、拔管(T 4)等各时点的平均动脉压(MAP)和心率(HR)以及术前、术毕、术后24 h的血糖GLU和乳酸LAC的变化情况;记录术后6 h、12 h、24 h的VAS评分;记录术后不良反应发生情况,患者下床活动、住院天数以及术前和出院时的髋关节功能评分(Harris评分)。结果F组患者T 1~T 4时点MAP和HR、围术期血糖及乳酸水平、6 h、12 h、24 h的VAS评分、术后不良反应发生率以及下床活动、住院时间明显低于C组,出院时的Harris评分高于C组,差异有统计学意义(P<0.05)。结论超声引导下髂筋膜间经阻滞复合浅全麻用于髋关节置换术中,可稳定患者血流动力学,减轻机体的应激反应,降低不良反应发生率,相比于传统的全麻方法更加安全可靠,值得在临床上进一步推广和应用。

Objective To investigate the effects of ultrasound-guided fascia iliaca compartment block(FICB)combined with superficial general anesthesia in hip replacement in elderly patients and its influence on postoperative recovery.Methods A total of 60 elderly patients,aged 65~102 years old and grade ASAⅡ~Ⅲ,who underwent selective hip replacement under general anesthesia in our hospital from June 2018 to June 2019,were selected as study subjects.The patients were randomly divided into nerve block combined with superficial general anesthesia group(group F)and simple general anesthesia group(group C),with 30 cases each group.The patients in both groups completed the operation under general anesthesia,and the patients in group F underwent ultrasound-guided fascia iliaca compartment block before surgery,while the patients in group C did not receive any treatment.Mean arterial pressure(MAP)and heart rate(HR)at entry(T 0),position(T 1),5min after skin resection(T 2),medullary cavity(T 3)and extubation(T 4),as well as blood glucose GLU and lactate LAC changes before,finish and 24h after surgery were recorded.VAS scores at 6h,12h and 24h after operation were recorded.The incidence of adverse reactions after the operation,the patient's activity of getting out of bed,the number of days in hospital,and the hip function score before and after the discharge(Harris score)were recorded.Results The MAP and HR at time points from T 1 to T 4,perioperative blood glucose and lactic acid levels,VAS scores at 6h,12h and 24h after surgery,incidence of postoperative adverse reactions,activity of getting out of bed,and length of stay of patients in group F were significantly lower than those in group C,and the Harris scores at discharge were higher than those in group C,with statistically significant differences(P<0.05).Conclusions The application of ultrasound-guided fascia iliaca block combined with superficial general anesthesia in hip arthroplasty could stabilize the hemodynamics of patients,reduce the degree of stress response,and reduce the incidence of adverse reactions.Compared with traditional general anesthesia,this method is more safe and reliable,and is worthy of further promotion and application in clinical practice.