罗哌卡因混合右美托咪定髂筋膜间隙阻滞复合全身麻醉对老年髋部手术患者的影响

The influence of fascia iliaca compartment block by using ropivacaine complex with dexmedetomidine and general anesthesia on elderly patients undergoing hip surgery

目的 探讨超声引导下罗哌卡因混合右美托咪定髂筋膜间隙阻滞(FICB)复合全身麻醉对老年髋部手术患者的影响。方法 选择2020年3月—2022年3月本院收治的60例髋部手术老年患者作为研究对象,按随机数表法分为髂筋膜间隙阻滞复合全身麻醉组(F组)和单纯全身麻醉组(G组)两组,每组各30例。所有患者于全麻诱导前5分钟(T_(0))、手术结束时(T_(1))、术后24小时(T_(2))、术后48小时(T_(3))抽取非输液侧静脉血3 ml检测血清中肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、IL-6和TNF-α变化情况(ELISA法),观察两组患者唤醒时间、术毕NRS评分、术中瑞芬太尼用量及术中和术后不良反应情况。结果 在T_(1)-T_(3),F组患者的血浆cTnI、CK-MB、IL-6和TNF-α比G组明显降低(P<0.05)。F组在术中的瑞芬太尼使用量、唤醒时间、术毕NRS评分、镇痛泵按压次数明显低于G组(P<0.05),恶心呕吐G组有8例,F组有4例(P<0.05)。结论 超声引导下罗哌卡因混合右美托咪定髂筋膜间隙阻滞(FICB)可以减轻老年髋部手术患者IL-6、TNF-α、cTnI、CK-MB的上升程度,有心肌保护作用。

Objective To investigate the influence of ultrasound-guided fascia iliaca compartment block(FICB)by using ropivacaine combined with dexmedetomidine and general anesthesia in elderly patients undergoing hip surgery.Methods Sixty elderly patients underwent hip operation those were admitted to our hospital from March 2020 to March 2022 were selected as research objects,and they were divided into two groups of fascia iliaca compartment block combined with general anesthesia(group F)and single general anesthesia group(G)according to random number table,with 30 cases in each group.At 5 minutes before induction of general anesthesia(T_(0)),at the end of operation(T_(1)),24 hours after operation(T_(2))and 48 hours after operation(T_(3)),3 ml blood samples were collected from the non-infusion side of the patients to detect the changes of serum cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),IL-6 and TNF-α(ELISA).The wake-up time,NRS score at the end of operation,intraoperative dosage of remifentanil,and intraoperative and postoperative adverse reactions were observed in the two groups.Results The plasma concentrations of cTnI,CK-MB,IL-6 and TNF-αwere significantly decreased in group F compared with those in group G(P<0.05).The remifentanil consumption doses,wake-up time,NRS score,the effective press frequency of patient-controlled analgesic pump,the postoperative untoward effects of nausea and vomiting in group F were significantly lower than those in group G(P<0.05).Conclusions Ultrasound-guided ropivacaine combined with dexmedetomidine fascia iliaca compartment block can decrease the rise degree of cTnI,CK-MB,IL-6 and TNF-αin patients undergoing hip surgery and presents myocardial protection effects.