不同浓度罗哌卡因超声下髂筋膜间隙阻滞在老年患者髋关节置换术中的应用效果

Application effect of different concentrations of ropivacaine for ultrasoundguided fascia iliaca compartment block in elderly patients undergoing hip replacement

目的探讨不同浓度罗哌卡因超声下髂筋膜间隙阻滞在老年患者髋关节置换术中的应用效果。方法选取我院2020年1月至12月收治的120例行全麻下髋关节置换术老年患者,随机将其分为A组、B组、C组,每组40例。三组患者均行超声下髂筋膜间隙阻滞联合全麻。A组给予0.5%罗哌卡因进行麻醉,B组给予0.25%罗哌卡因进行麻醉,C组给予0.15%罗哌卡因进行麻醉。比较三组不同时间点的血流动力学指标、应激反应指标、疼痛程度及感觉、运动阻滞情况。结果切皮前(T_(2))、切皮后(T_(3))时,三组的平均动脉压(MAP)、心率(HR)均减小(P<0.05);T_(2)时,B组的MAP大于A、C组(P<0.05);T_(2)、T_(3)时,B组的HR大于A、C组(P<0.05)。髂筋膜间隙阻滞后20 min(T_(1))、T_(2)、T_(3)时,三组的皮质醇(Cor)、去甲肾上腺素(NE)水平均升高,且C组高于A、B组(P<0.05)。术后6 h(T_(4))、术后12 h(T_(5))、术后24 h(T_(6))时,三组的视觉模拟评分法(VAS)评分均降低,但C组高于A、B组(P<0.05)。B组的平面消退时间、运动阻滞恢复时间均长于A、C组,运动阻滞起效时间短于A、C组(P<0.05)。结论不同浓度罗哌卡因超声下髂筋膜间隙阻滞在髋关节置换术中均具有一定的应用价值,其中浓度为0.25%的罗哌卡因麻醉效果更优,安全性更高。

Objective To investigate the application effect of different concentrations of ropivacaine for ultrasound-guided fascia iliaca compartment block in elderly patients undergoing hip replacement.Methods A total of 120 elderly patients undergoing hip replacement under general anesthesia admitted to our hospital from January to December 2020 were randomly divided into group A,B and C,with 40 cases in each group.Three groups of patients underwent ultrasound guided fascia iliaca compartment block combined with general anesthesia.The group A was given 0.5%ropivacaine for anesthesia,the group B was given 0.25%ropivacaine for anesthesia,and the group C was given 0.15%ropivacaine for anesthesia.The hemodynamic indexes,stress response indexes,pain degree and sensory and motor block were compared among the three groups at different time points.Results Before skin incision(T_(2))and after skin incision(T_(3)),the mean arterial pressure(MAP)and heart rate(HR)of the three groups decreased(P<0.05).At T_(2),the MAP in the group B was greater than that in the group A and C(P<0.05).At T_(2) and T_(3),the HR in the group B was greater than that in the group A and C(P<0.05).At 20 min after fascia iliaca compartment block(T_(1)),T_(2) and T_(3),the levels of cortisol(Cor)and norepinephrine(NE)in the three groups increased,and those in the group C were higher than the group A and B(P<0.05).At 6 h after operation(T_(4)),12 h after operation(T_(5))and 24 h after operation(T_(6)),the Visual Analogue Scale(VAS)score of the three groups decreased,but that in the group C was higher than the group A and B(P<0.05).The plane regression time and motor block recovery time of the group B were longer than those of the group A and C,and the onset time of motor block was shorter than that of the group A and C(P<0.05).Conclusion Ultrasound-guided fascia iliaca compartment block with different concentrations of ropivacaine has certain application value in hip replacement.0.25%ropivacaine has better anesthesia effect and higher safety among them.