帕瑞昔布钠预处理联合超声引导下多点髂筋膜间隙阻滞在老年全髋关节置换术中的应用

Application of parecoxib sodium pretreatment combined with ultrasound–guided multipoint fascia iliaca compartment block in elderly patients undergoing total hip arthroplasty

目的探讨帕瑞昔布钠预处理联合超声引导下多点髂筋膜间隙阻滞(fascia iliaca compartment block,FICB)在老年全髋关节置换术(total hip arthroplasty,THA)中的应用效果。方法选取2019年1月至2021年5月在台州市第一人民医院接受择期THA的老年患者134例,按照随机数字表法将其分为观察组与对照组,每组各67例。对照组患者接受超声引导下单点FICB,观察组患者接受帕瑞昔布钠预处理联合超声引导下多点FICB。比较两组患者的感觉神经阻滞起效时间、注药30min后神经阻滞成功率、术中血流动力学水平、术后视觉模拟评分法(visual analogue scale,VAS)评分和尼卡地平、麻黄碱、术后24h患者自控镇痛(patient–controlled analgesia,PCA)用量及并发症发生率。结果两组患者的手术时间、股神经阻滞起效时间及注药30min后阻滞成功率比较,差异均无统计学意义(P>0.05);观察组患者的股外侧皮神经及闭孔神经阻滞起效时间均显著短于对照组,注药30min后阻滞成功率均显著高于对照组(P<0.05);观察组患者在手术切皮时(T1)、手术扩髓时(T2)、假体植入时(T3)、切口缝合时(T4)及入复苏室后(T5)的平均动脉压均显著低于对照组(P<0.05),观察组患者在T2、T3、T4、T5时间点的心率均显著低于对照组(P<0.05);观察组患者术后2h、6h、12h、24h时的VAS评分均显著低于对照组(P<0.05);观察组患者的术中尼卡地平、麻黄碱用量及术后24h PCA用量均显著低于对照组(P<0.05)。两组患者的术后并发症发生率比较差异无统计学意义(P>0.05)。结论帕瑞昔布钠预处理联合超声引导下多点FICB应用于老年THA患者,神经阻滞速度快,术中血流动力学水平稳定,术后镇痛效果良好。

Objective To investigate the effect of parecoxib sodium pretreatment combined with ultrasound–guided multipoint fascia iliaca compartment block(FICB)in elderly patients undergoing total hip arthroplasty(THA).Methods A total of 134 elderly patients who received elective THA in Taizhou First People’s Hospital from January 2019 to May 2021 were selected and divided into observation group and control group according to the random number table method,with 67 cases in each group.Patients in control group received ultrasound–guided single–point FICB and patients in observation group received parecoxib sodium combined with ultrasound–guided multipoint FICB.The onset time of sensory nerve block,the success rate of nerve block 30 minutes after drug injection,intraoperative hemodynamic level,postoperative visual analogue scale(VAS)score,the dosage of nicardipine,ephedrine,and patient–controlled analgesia(PCA)at 24 hours after operation and the incidence of complications were compared between the two groups.Results There was no significant difference in operation time,onset time of femoral nerve block and success rate of block 30min after injection between the two groups(P>0.05).The onset time of lateral femoral cutaneous nerve block and obturator nerve block in observation group was significantly shorter than that in control group,and the success rate of block 30min after injection was significantly higher than that in control group(P<0.05).The mean artery pressure of observation group was lower than that of control group at the time of incision(T1),surgical medullary reaming(T2),prosthesis implantation(T3),incision suture(T4)and after entering the resuscitation chamber(T5)(P<0.05),and the heart rate of observation group was higher than that of control group at T2,T3,T4 and T5(P<0.05).The VAS scores at 2h,6h,12h and 24h after operation were significantly lower than those of control group(P<0.05).The dosage of nicardipine and ephedrine during operation and PCA at 24h after operation in observation group were significantly lower than those in control group(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion Parecoxib sodium pretreatment combined with multipoint FICB guided by ultrasound in elderly patients with THA has fast nerve block speed,stable intraoperative hemodynamic level,and good postoperative analgesia effect.