超声引导下腰方肌阻滞与髂筋膜间隙阻滞在老年髋部骨折术前镇痛的应用比较

Application comparison of ultrasound-guided quadratus lumborum block and fascia iliaca compartment block in preoperative analgesia for the elderly with hip fractures

目的比较超声引导下腰方肌阻滞(QLB)与髂筋膜间隙阻滞(FICB)老年髋部骨折创伤早期镇痛效果及可行性。方法选取2018年1月至2019年6月本院收治的髋部骨折限期手术患者80例,采用随机数表法分为两组,每组40例。观察组于超声引导下行前路QLB,对照组患者于超声引导下行FICB,注入0.375%罗哌卡因30 ml。于注药前(T0)、注药后0.5 h(T1)、1 h(T2)、1.5 h(T3)、2 h(T4)、2~4 h(T5)、4~8 h(T6)、8~12 h(T7)、12~24 h(T8)、24~36 h(T9)、36~48 h(T10)采用视觉模拟(VAS)评分法评估两组患者静息和被动活动状态下疼痛程度;比较两组患者48 h内被动活动时平均动脉压(MAP)、心率(HR)变化;记录神经阻滞操作时间及神经阻滞起效时间及维持时间;统计两组患者总体满意度情况及不良事件的发生情况。结果静息状态时观察组患者于T9、T10时VAS评分均显著低于对照组(均P<0.05);被动活动状态时,观察组患者于T1、T2、T3、T4、T5、T6、T7、T8、T9、T10时VAS评分均显著低于对照组(均P<0.05);两组患者神经阻滞起效时间、不良反应发生情况比较差异均无统计学意义(均P>0.05);观察组患者神经阻滞操作时间显著高于对照组(P<0.05),神经阻滞维持时间、满意度得分均显著高于对照组(均P<0.05)。结论腰方肌阻滞较髂筋膜间隙阻滞更能明显降低髋部骨折静息及动态痛,尤其明显降低髋关节被动活动时的疼痛评分,阻滞镇痛维持时间更长,作为髋部骨折术前镇痛是安全和有效的。

Objective To compare early trauma analgesia effect of ultrasound-guided quadratus lumborum block(QLB)and fascia iliaca compartment block(FICB)on the elderly with hip fractures and feasibility.Methods 80 patients with hip fractures who underwent confine operation and were admitted to our hospital from January 2018 to June 2019 were enrolled.They were divided into observation group and control group by the random number table,40 cases in each group.The observation group underwent ultrasound-guided QLB,while the control group underwent ultrasound-guided FICB.They were injected with 0.375%ropivacaine for 30 ml.Before injection(T0),0.5 h(T1),1 h(T2),1.5 h(T3),2 h(T4),2-4 h(T5),4-8 h(T6),8-12 h(T7),12-24 h(T8),24-36 h(T9),and 36-48 h(T10)after injection,visual analog scale(VAS)was applied to evaluate pain degree at rest and passive activity status in both groups.The changes in mean arterial pressure(MAP)and heart rate(HR)at passive activity status within 48 h were compared between the two groups.The operation time,onset time and maintenance time of nerve block were recorded.The overall satisfaction and occurrence of adverse events in both groups were statistically analyzed.Results At T9 and T10,VAS scores of the observation group at rest status were significantly lower than those of the control group(all P<0.05).At T1,T2,T3,T4,T5,T6,T7,T8,T9,and T10,VAS scores in the observation group at passive activity status were significantly lower than those in the control group(all P<0.05).There were no statistically significant differences in onset time of nerve block or the incidence of adverse reactions between the two groups(all P>0.05).The operation time of nerve block in the observation group was significantly longer than that in the control group(P<0.05).The maintenance time of nerve block and satisfaction score in the observation group were significantly higher than those in the control group(all P<0.05).Conclusion Compared with FICB,QLB can significantly alleviate the pain of hip fractures at rest and passive activity status.Especially,it can significantly decrease pain score at hip passive activity status,prolong maintenance time of nerve block,which can be applied as a method for preoperative analgesia of hip fracture.