超声引导下腹股沟上髂筋膜阻滞和腰丛阻滞在老年髋部手术中麻醉效果的比较

Comparison of Anesthetic Effects of Ultrasound-guided Suprainguinal Fascia Iliaca Block and Lumbar Plexus Block in Elderly Hip Surgery

目的观察超声引导下腹股沟上髂筋膜阻滞和腰丛阻滞在老年髋部手术中麻醉效果。方法选取2019年3月-2022年3月在我院行髋部手术的90例老年患者为研究对象,采用随机数字表法分为对照组和观察组,各45例。两组均于气管插管全麻前均在超声下行神经阻滞,对照组给予腰丛阻滞,观察组给予腹股沟上髂筋膜阻滞。比较两组阻滞操作时间、阻滞起效时间、不同时间点[阻滞5 min(T0)、开始切皮时(T1),手术结束时(T2),气管拔管时(T3)]平均动脉压(MAP)和心率(HR)、术后不同时间点(术后6、12、24 h)疼痛(VAS)评分和Ramsay镇静评分、不良反应发生率。结果观察组阻滞操作时间短于对照组,阻滞起效时间长于对照组(P<0.05);T1、T2、T3时间点MAP、HR均高于T0,但观察组低于对照组(P<0.05);术后6、12、24 h观察组VAS评分、Ramsay镇静评分与对照组比较,差异无统计学意义(P>0.05);观察组不良反应发生率为11.11%,与对照组的13.33%比较,差异无统计学意义(P>0.05)。结论超声引导下腹股沟上髂筋膜阻滞操作简单,且可与腰丛阻滞获得基本相似的麻醉、镇痛效果。同时在T0、T1、T2、T3时间点对MAP、HR影响相对较小,可维持血流动力学基本稳定,是一种安全、有效的阻滞方式。

Objective To observe the anesthetic effect of ultrasound-guided suprainguinal iliac fascia block and lumbar plexus block in elderly hip surgery.Methods A total of 90 elderly patients who underwent hip surgery in our hospital from March 2019 to March 2022 were selected as the research objects.They were divided into control group and observation group by random number table method,with 45 cases in each group.Both groups were given nerve block under ultrasound before tracheal intubation general anesthesia.The control group was given lumbar plexus block,and the observation group was given superior inguinal iliac fascia block.The block operation time,block onset time,mean arterial pressure(MAP)and heart rate(HR)at different time points[block 5 min(T0),skin incision(T1),end of operation(T2),tracheal extubation(T3)],pain(VAS)score and Ramsay sedation score at different time points after operation(6,12,24 h after operation),and incidence of adverse reactions were compared between the two groups.Results The block operation time in the observation group was shorter than that in the control group,and the block onset time was longer than that in the control group(P<0.05).MAP and HR at T1,T2 and T3 were higher than those at T0,but those in the observation group were lower than those in the control group(P<0.05).There was no significant difference in VAS score and Ramsay sedation score between the observation group and the control group at 6,12 and 24 h after operation(P>0.05).The incidence of adverse reactions in the observation group was 11.11%,which was compared with 13.33%in the control group,the difference was not statistically significant(P>0.05).Conclusion Ultrasound-guided suprainguinal fascia iliaca compartment block is simple and can achieve similar anesthetic and analgesic effects as lumbar plexus block.At the same time,at T0,T1,T2 and T3 time points,it has a relatively small impact on MAP and HR,and can maintain the basic stability of hemodynamics.It is a safe and effective block method.