UIFB联合羟考酮PCIA在髋部骨折手术加速康复中的效果评价

Evaluation of ultrasound-guided iliaca fascia block combined with patient-controlled intravenous analgesia using oxycodone in accelerating rehabilitation after hip orthopedic surgery

目的评价超声引导下髂筋膜阻滞(ultrasound-guided iliac fascia block,UIFB)联合羟考酮患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)在髋部骨折患者术后康复中的效果。方法选取蛛网膜下腔阻滞麻醉下行髋部骨折内固定术的患者75例,按随机数字表法分为PCIA组(Ⅰ组)、UIFB组(Ⅱ组)、UIFB联合PCIA组(Ⅲ组),每组25例。Ⅰ组患者常规施行蛛网膜下腔阻滞,Ⅱ组、Ⅲ组患者在蛛网膜下腔阻滞前先行患侧UIFB;术后Ⅰ组、Ⅲ组患者连接PCIA泵,配方均为羟考酮50 mg+托烷司琼6 mg+生理盐水稀释至100 ml,自控镇痛单次剂量4 ml,锁定时间5 min。记录3组患者术后6、12、24、36、48 h VAS疼痛评分,术后24、48 h患侧髋关节的外展度和屈曲度,术后48 h恶心呕吐、皮肤瘙痒、嗜睡、呼吸抑制等不良反应发生情况,记录3组患者对镇痛效果满意的比例及住院天数,记录Ⅰ组和Ⅲ组患者术后48 h羟考酮总用量及PCIA有效按压次数。结果术后6、12、24、36 hⅡ组、Ⅲ组患者VAS疼痛评分低于Ⅰ组(P<0.05),Ⅲ组患者VAS疼痛评分低于Ⅱ组(P<0.05);Ⅱ组、Ⅲ组患者住院天数少于Ⅰ组(P<0.05),Ⅲ组患者住院天数少于Ⅱ组(P<0.05);Ⅲ组患者术后48 h羟考酮总用量低于Ⅰ组,术后48 h PCIA有效按压次数少于Ⅰ组(P<0.05);术后24、48 hⅡ组、Ⅲ组患者患侧髋关节屈曲度、外展度大于Ⅰ组(P<0.05),Ⅲ组患者患侧髋关节屈曲度、外展度大于Ⅱ组(P<0.05);Ⅱ组、Ⅲ组患者恶心呕吐、嗜睡发生率低于Ⅰ组(P<0.05),Ⅲ组患者恶心呕吐发生率低于Ⅱ组(P<0.05)。Ⅱ组、Ⅲ组对镇痛效果满意的患者比例高于Ⅰ组(P<0.05),Ⅲ组对镇痛效果满意的患者比例高于Ⅱ组(P<0.05)。结论与传统的PCIA方式或单纯UIFB相比,UIFB联合羟考酮PCIA在骨科髋部手术后镇痛效果确切,增加患者患侧髋关节最大外展度和屈曲度,减少阿片类镇痛药的相关不良反应,可加速患者术后康复。

Objective To evaluate the effect of ultrasound-guided iliaca fascia block(UIFB)combined with patient-controlled intravenous analgesia(PCIA)using oxycodone on the postoperative rehabilitation in patients undergoing hip orthopedic surgery.Methods A total of 75 patients who underwent hip orthopedic surgery under spinal anesthesia were enrolled.According to the random number table method,they were divided into three groups(n=25):a PCIA group(group Ⅰ),a UIFB group(group Ⅱ),and a UIFB+PCIA group(group Ⅲ).Spinal anesthesia was routinely performed in groupⅠ,while UIFB was performed on the affected side in group Ⅱ and group Ⅲ before spinal anesthesia.After surgery,patients in groups Ⅰ and Ⅱ were connected with PCIA pumps which contained 50 mg oxycodone and 6 mg tropisetron in 100 ml normal saline and were programmed to deliver 4 ml each time with a terval of 5 min.The Visual Analog Scale(VAS)scores 6,12,24,36 h and 48 h after surgery,the flexion and abduction of the affected hip joint 24 h and 48 h after surgery,and the incidences of adverse reactions,such as nausea and vomiting,itchy skin,drowsiness and respiratory suppression,etc.48 h after surgery were recorded.The percentage of overall satisfaction and the length of hospitalization stay were recorded.The total doses of oxycodone 48 h after surgery and the effective pressing number of PCIA pump were recorded in group Ⅰ and group Ⅲ.Results In the current study,6,12,24 h and 36 h after surgery,patients in group Ⅱ and group Ⅲ presented lower VAS scores than group Ⅰ(P<0.05),and group Ⅲ presented lower VAS scores than group Ⅱ(P<0.05);patients in group Ⅱ and group Ⅲ showed shorter length of hospitalization stay than group I(P<0.05),and group Ⅲ presented shorter length of hospitalization stay than group Ⅱ(P<0.05).Patients in group Ⅲ showed less oxycodone consumption,and a less effective pressing number of PCIA pump than group Ⅰ 48 h after surgery(P<0.05).Patients in group Ⅱ and group Ⅲ showed larger flexion and abduction of the affected hip joint than group Ⅰ(P<0.05)and group Ⅲ showed larger flexion and abduction of the affected hip joint than group Ⅱ 24 h and 48 h after surgery(P<0.05).Patients in group Ⅱ and group Ⅲ showed lower incidences of nausea,vomiting and drowsiness than group Ⅰ(P<0.05),and group Ⅲ showed lower incidences of nausea and vomiting than group Ⅰ(P<0.05).Patients in group Ⅱ and group Ⅲ showed a higher percentage of overall satisfaction than group Ⅰ(P<0.05),and group Ⅲ showed a higher percentage of overall satisfaction than group Ⅱ(P<0.05).Conclusions Compared to traditional PCIA or UIFB alone,UIFB combined with PCIA improves the analgesic effect and the flexion and abduction of the affected hip joint,decreases the incidences of adverse reactions related to opioid analgesics,and accelerates rehabilitation after surgery.