超声引导下髂筋膜间隙阻滞复合单侧脊椎麻醉行髋关节置换术的临床研究

Clinical study on ultrasound-guided iliac fascial space block combined with unilateral spinal anesthesia for hip replacement surgery

目的探讨超声引导下髂筋膜间隙阻滞+单侧脊椎麻醉在老年股骨颈骨折后路髋关节置换术中的应用效果。方法选择阳江市中医医院麻醉科2021年1月—7月开展后路髋关节置换术的老年股骨颈骨折患者50例为研究对象,采用随机数字表法分为对照组25例与观察组25例,对照组采用腰硬联合麻醉,观察组采用超声引导下髂筋膜间隙阻滞+单侧脊椎麻醉,比较两组麻醉效果、血压波动、感觉与运动时间、术后镇痛泵使用情况、术后疼痛情况及不良反应发生情况。结果观察组麻醉优良率高于对照组,差异有统计学意义(P<0.05);观察组血压波动优良率高于对照组,差异有统计学意义(P<0.05);观察组感觉阻滞时间、运动阻滞时间、感觉恢复时间、运动恢复时间短于对照组,差异有统计学意义(P<0.05);观察组首次按压镇痛泵时间晚于对照组,术后48 h内按压镇痛泵次数与补救镇痛次数少于对照组,差异有统计学意义(P<0.05);观察组术后4 h、8 h、24 h静息视觉模拟评分法(VAS)评分与术后12、24 h运动VAS评分均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导下髂筋膜间隙阻滞复合单侧脊椎麻醉在老年股骨颈骨折后路髋关节置换术中麻醉效果优于腰硬联合麻醉,可使患者血压波动不明显,缩短感觉与运动时间,缓解术后疼痛,且不增加不良反应。

Objective To investigate the effect of ultrasound-guided iliac fascial space block and unilateral spinal anesthesia in posterior hip arthroplasty for elderly femoral neck fractures.Methods Fifty elderly patients with femoral neck fractures undergoing posterior hip arthroplasty in the Department of Anesthesiology,Yangjiang Hospital of Traditional Chinese Medicine from January to July 2021 were selected and divided into a control group and an observation group,with 25 cases in each group.The control group was treated with combined spinal-epidural anesthesia,and the observation group was treated with ultrasound-guided iliac fascial space block combined with unilateral spinal anesthesia.Anesthesia effects,blood pressure fluctuations,sensory and motor-related time,and postoperative analgesic pump usage,pain,and adverse reactions were compared between the two groups.Results The excellent and good rate of anesthesia in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05);the excellent and good rate of blood pressure fluctuation in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05);the sensory block time,motor block time,sensory recovery time,and motor recovery time were shorter in the observations group than in the control group,and the differences were statistically significant(P<0.05);the observation group first pressed the analgesic pump later than the control group,pressed less times of analgesic pumps within 48 h after operation,and conducted less number of remedial analgesia,and the differences were statistically significant(P<0.05);the observation group showed lower at-rest Visual Analog Scale(VAS)scores at postoperative 4 h,8 h,and 24 h,as well as during-movement VAS scores at postoperative 12 h and 24 h than the control group,the differences were statistically significant(P<0.05);the difference in the incidence of adverse reactions between the two groups was not statistically significant(P>0.05).Conclusion Ultrasound-guided iliac fascial space block plus unilateral spinal anesthesia shows a better anesthesia effect than combined spinal-epidural anesthesia during posterior hip arthroplasty for elderly femoral neck fractures,which can shorten sensory and motor-related time and relieve postoperative pain,with little influence on patients’blood pressure,and induce few adverse reactions.