超声引导下髂前上棘水平髂筋膜间隙阻滞在发育性髋关节脱位手术患儿中的应用

Application of ultrasound⁃guided fascia iliaca compartment block at the level of anterior superior ili⁃ac spine in children with developmental dislocation of the hip received the surgery

目的探讨超声引导下髂前上棘水平髂筋膜间隙阻滞用于发育性髋关节脱位手术患儿的有效性和安全性。方法选择发育性髋关节脱位拟行髋臼成形及股骨截骨手术患儿59例,男14例,女45例,年龄1~5岁,体重9.5~21.0 kg,ASAⅠ或Ⅱ级,随机分为两组:超声引导下髂前上棘水平髂筋膜间隙阻滞组(UF组,n=30)和单纯全麻组(GA组,n=29)。UF组插管后行超声引导下患侧髂前上棘水平髂筋膜间隙阻滞,0.2%罗哌卡因0.8~1.0 ml/kg,最大用量小于20 ml,30 min后开始手术。GA组不行阻滞直接开始手术。记录麻醉诱导前1 min、手术开始后1、10、30、60 min、手术结束时的MAP、HR和呼出气七氟醚浓度(C_(ET)Sev)以及术中芬太尼、瑞芬太尼和丙泊酚使用量、拔管时间、苏醒时间,拔管后10、20、30 min、出室时的苏醒期躁动(PAED)评分,术后4、8、12、24、48 h的FLACC疼痛评分和曲马多补救镇痛及不良反应情况。结果手术开始后1 min至手术结束时,UF组C_(ET)Sev明显低于GA组(P<0.05)。UF组术中芬太尼、瑞芬太尼和丙泊酚用量均明显少于GA组(P<0.05),拔管时间和苏醒时间明显短于GA组(P<0.05)。拔管后10、20、30 min时UF组PAED评分均明显低于GA组(P<0.05)。术后4、8、12 h,UF组FLACC评分明显低于GA组(P<0.05)。GA组有6例(21%)需曲马多补救镇痛,UF组无一例补救镇痛(P<0.05)。两组不良反应发生率差异无统计学意义。结论超声引导下髂前上棘水平髂筋膜间隙阻滞可为发育性髋关节脱位手术患儿提供较为完善的镇痛,减少全麻药和阿片类药物用量,促进术后早期恢复。

Objective To investigate the efficacy and safety of ultrasound-guided fascia iliaca compartment block at the level of anterior superior iliac spine in children undergoing surgery for developmental dislocation of hip.Methods Fifty-nine pediatric patients with developmental dislocation of the hip undergoing acetabular plasty and femoral osteotomy were selected,14 males and 45 females,aged 1-5 years,weighing 9.5-21.0 kg,ASA physical statusⅠorⅡ,randomly divided into ultrasound-guided fascia iliaca compartment block group(group UF,n=30)and general anesthesia group(group GA,n=29).Patients in group UF received ultrasound-guided fascia iliaca compartment block at the level of anterior superior iliac spine after intubation.MAP,HR,and exhaled concentration of sevoflurane(C_(ET)Sev)at 1 min,10 min,30 min,60 min after skin incision and the end of surgery,as well as the consumption of fentanyl,remifentanil and propofol during the procedure,extubation time,and wake-up time were recorded.PAED scores at 10 min,20 min,30 min after extubation and discharging,and FLACC scores at 4 h,8 h,12 h,24 h and 48 h after the surgery were valuated.The number of children needing remedial tramadol and the incidence of adverse reactions were recorded.Results Compared with group GA,C_(ET)Sev at at 1 min,10 min,30 min,1 h after skin incision and the end of surgery,and the consumption of fentanyl,remifentanil and propofol during the procedure were significantly lower in group UF(P<0.05);the extubation time and wake-up time were shorter in group UF(P<0.05);PAED scores at 10 min,20 min,30 min after extubation and FLACC scores at 4 h,8 h,12 h after the surgery were significantly lower in group UF(P<0.05).There were 6(21%)children received remedial tramadol in group GA,whereas no children received remedial analgesia.There was no statistic difference in the incidence of adverse reactions.Conclusion Ultrasound-guided fascia iliaca compartment block at the level of anterior superior iliac spine can provide more perfect analgesia during the surgery and within 12 h after surgery for children with developmental dislocation of the hip,mean while it reduces the consumption of general anesthetics and opioids and sedatives,and brings about early recovery.