超声引导下股神经阻滞和髂筋膜间隙阻滞在老年患者全髋关节置换术中的麻醉效果比较

Comparison of the anesthetic effects of ultrasound-guided femoral nerve block and fascia iliaca compartment block in elderly patients undergoing total hip arthroplasty

目的比较超声引导下股神经阻滞和髂筋膜阻滞在老年患者全髋关节置换术中的麻醉效果。方法选择徐州仁慈医院2020年1—12月择期进行老年全髋关节置换手术患者80例,根据随机数字表法分为股神经入路阻滞组(A组,n=40)和髂筋膜间隙入路阻滞组(B组,n=40)。两组均在超声引导下进行,比较分析两组患者术中丙泊酚、瑞芬太尼的用量及不同时间点心率(HR)、平均脉动压(MAP),比较分析术后不同时间点静态疼痛视觉模拟评分(VAS)、PCA自控使用次数、不良反应发生率和患者满意度。结果B组丙泊酚、瑞芬太尼的术中用量低于A组(P<0.05),B组术中15、30 min MAP,术后6、12、24 h静态VAS评分低于A组(P<0.05);B组术后PCA的按压次数低于A组(P<0.05)。B组并发症发生率低于A组,总满意度高于A组(P<0.05)。结论超声引导髂筋膜间隙阻滞镇痛在全髋关节置换术患者中的应用效果显著优于股神经阻滞,可有效降低疼痛程度及不良反应发生情况。

Objective To c ompare t he a nesthetic effects o f ul trasound-guided f emoral ne rve b lock(FNB)and fascia iliaca compartment block(FICB)in elderly patients undergoing total hip arthroplasty(THA).Methods A total of 80 patients undergoing elective THA in our hospital from January to December 2020 were randomly divided into the FNB group(group A,n=40)and the FICB group(group B,n=40)according to the random number table method.The surgeries performed on both groups were under ultrasound guidance.The intraoperative dosage of propofol and remifentanil,and the heart rates(HR)and mean arterial pressure(MAP)at different time points of the two groups were comparatively analyzed.In addition,the postoperative static pain score by Visual Analogue Scale(VAS)at different time points,the number of using patient-controlled analgesia(PCA),the incidence of adverse reactions and patient satisfaction of the two groups were comparatively analyzed.Results The intraoperative dosage of propofol and remifentanil in group B was less than that in group A(P<0.05).The intraoperative MAP at 15 min and 30 min,and the static VAS scores assessed at 6 h,12 h and 24 h after surgery in group B were lower than those in group A(P<0.05).The number of pressing the PCA pump after surgery in group B was lower than that in group A(P<0.05).The incidence of adverse reactions of B group was lower than A group,and the total satisfaction of B group was higher than A group(P<0.05).Conclusion The analgesic effect of ultrasound-guided FICB is significantly better than that of FNB in patients undergoing THA,and the former can effectively reduce pain and the occurrence of adverse reactions.