超声引导下腹股沟韧带上髂筋膜间隙阻滞在老年股骨颈骨折人工关节置换术中的应用效果

The Effect of Ultrasound-guided Inguinal Ligament and Superior Iliac Fascial Space Block in Artificial Joint Replacement for Elderly Femoral Neck Fractures

目的探究超声引导下的腹股沟韧带上髂筋膜间隙阻滞(supra-inguinal fascia iliaca compartment block,S-FICB)联合椎管内麻醉方法与传统的椎管内麻醉方式在老年人股骨颈骨折人工关节置换手术围术期的作用差异。方法选取2020年7月—2021年7月该院收治的股骨颈骨折老年患者60例,ASA分级为Ⅰ~Ⅳ级,患者年龄65~100岁,均行人工关节置换(包括人工股骨头置换)手术治疗,采用随机数表法分为观察组(C组)和对照组(N组)各30例,C组采用超声引导下S-FICB联合椎管内麻醉;N组即单纯椎管内麻醉。观察记录两组不同麻醉方式的患者在椎管内麻醉体位摆放时(T1)、切皮前(T2)、切皮后(T3)及术毕(T4)等体位变动时的不同时间点的疼痛评分、血流动力学情况及呼吸情况,术中血管活性药物用药情况,手术时间,出血量,记录患者术毕4、8、12 h的疼痛评分;第1次补救镇痛时间、补救镇痛次数、术后镇痛不良反应发生率;术后满意度调查。结果发现C组患者在椎管内麻醉体位摆放时(T1)及术毕(T4)的血流动力学情况均优于N组患者,差异有统计学意义(P<0.05),术中血管活性药物用药次数及术中出血量少于N组,差异有统计学意义(P<0.05),疼痛评分低于N组,差异有统计学意义(P<0.05)。C组第1次镇痛补救时间在(199.56±8.51)min后,而N组在(71.93±11.40)min后,即C组迟于N组,差异有统计学意义(t=-49.130,P<0.05);C组镇痛补救次数为(3.57±1.45)次,而N组为(7.5±2.03)次,即C组补救镇痛次数少于N组,差异有统计学意义(t=8.630,P<0.05);C组术后不良反应发生率为(6.67±25.00)%,低于N组的(40.00±50.00)%,差异有统计学意义(t=3.270,P<0.05);C组术后满意度为(8.9±1.67)分,高于N组的(5.3±1.44)分,差异有统计学意义(t=-8.940,P<0.05)。结论S-FICB联合椎管内麻醉技术要比单纯的椎管内麻醉操作更适用于老年股骨颈骨折人工关节置换手术。

Objective To explore the difference in the perioperative effects of the ultrasound-guided supra-inguinal fascia iliaca compartment block(S-FICB) combined with spinal anesthesia and traditional spinal anesthesia in the femoral neck artificial joint replacement surgery for fractures of the elderly.Methods A total of 60 elderly patients with femoral neck fractures admitted to the hospital from July 2020 to July 2021 were selected.The ASA classification was Ⅰ to Ⅳ,and the patients are 65 to 100 years old.All patients underwent artificial joint replacement(including artificial femoral head replacement) surgical treatment.Using random number table method,they were divided into observation group(group C) and control group(group N) with 30 cases each.Group C was treated with ultrasound-guided S-FICB combined with spinal anesthesia.Group N was simply intraspinal anesthesia.Observed and recorded the different time points of the two groups of patients with different anesthesia methods during the position of the spinal anesthesia(T1),before the skin incision(T2),after the skin incision(T3),and after the operation(T4).Pain score,hemodynamic status and breathing status,intraoperative vasoactive drug use status,operative time,blood loss,and the pain score of patients at 4,8,and 12 hours after the operation were recorded.The time of the first salvage analgesia,the number of salvage analgesia,and the incidence of postoperative analgesia adverse reactions.Postoperative satisfaction was investigated.Results It showed that the hemodynamics of patients in group C were better than those in group N,the difference was statistically significant(P<0.05) when placed in the spinal anesthesia position(T1) and after surgery(T4).The number of intraoperative vasoactive drugs and the number of operations bleeding was less than that of the N group,the difference was statistically significant(P<0.05),and the pain score was lower than that of the N group,the difference was statistically significant(P<0.05).The first salvage time of analgesia in group C was after(199.56±8.51) min,while in group N after(71.93±11.40)min,group C was later than group N,the difference was statistically significant(t=-49.130,P<0.05).The number of remedial analgesia in group C was(3.57±1.45)times,while that in group N was(7.5±2.03) times,that was,the number of remedial analgesia in group C was less than that in group N,the difference was statistically significant(t=8.630,P<0.05).The incidence of adverse reactions in group C was(6.67±25.00)%,which was lower than that in group N of(40.00±50.00)%,the difference was statistically significant(t=3.270,P<0.05).The postoperative satisfaction of group C was(8.9±1.67)points,which was higher than that of group N of(5.3±1.44)points,the difference was statistically significant(t=-8.940,P<0.05).Conclusion S-FICB combined with intraspinal anesthesia is more suitable for artificial joint replacement surgery for elderly femoral neck fractures than pure intraspinal anesthesia.