超声引导下髋关节囊周围神经阻滞在老年髋部骨折患者术前镇痛中的应用效果探讨

Application of Ultrasound-guided Pericapsular Nerve Block of Hip Joint in Preoperative Analgesia in Elderly Patients with Hip Fracture

目的探讨超声引导下髋关节囊神经阻滞在老年髋部骨折患者术前镇痛中的应用效果。方法随机选取2021年2月—2022年6月期间在南通大学第六附属医院接受治疗的老年髋部骨折患者86例为研究对象,通过随机数表法分为对照组(髂筋膜间隙阻滞)及观察组(超声引导下髋关节囊周围神经阻滞),各43例,观察两组患者不同时间点静息及运动状态下的VAS评分。结果两组患者阻滞前(T_(0))、6 h(T_(2))、手术麻醉前(T_(4))静息状态下视觉模拟量表(VAS)评分比较,差异无统计学意义(P>0.05);对照组阻滞30 min(T_(1))、24 h(T_(3))静息状态下VAS评分[(2.81±0.74)分、(1.31±0.32)分]高于观察组[(1.21±0.51)分、(1.11±0.42)分],差异有统计学意义(t=11.674、2.484,P<0.05);两组患者T_(0)、T_(2)、T_(4)时运动状态下VAS评分比较,差异无统计学意义(P>0.05);相较于对照组T1、T3时运动状态下VAS评分,观察组均更低,差异有统计学意义(t=13.784、15.818,P<0.001);两组患者T_(0)时股四头肌肌力评级比较,差异无统计学意义(P>0.05);对照组T_(1)、T_(2)、T_(3)、T_(4)时股四头肌肌力评级低于观察组,差异有统计学意义(P<0.05)。结论老年髋部骨折患者术前镇痛中应用超声引导下髋关节囊周围神经阻滞,可改善患者疼痛感及股四头肌肌力。

Objective To investigate the effect of ultrasound-guided pericapsular nerve block on preoperative analgesia in elderly patients with hip fracture.Methods Eighty-six elderly patients with hip fracture who were treated in the Sixth Affiliated Hospital of Nantong University from February 2021 to June 2022 were randomly selected as the study subjects.They were randomly divided into the control group(iliac fascial space block)and the observation group(ultrasound-guided hip pericapsular nerve block)with 43 cases each.The VAS scores of the two groups were observed at different time points at rest and in motion.Results There was no statistically significant difference in visual analog scale(VAS)scores before block(T0),6 h(T2)and before anesthesia(T4)at resting state between 2 groups(P>0.05).VAS scores at resting state at 30 min(T1)and 24 h(T3)in control group[(2.81±0.74)points,(1.31±0.32)points]were higher than those in observation group[(1.21±0.51)points,(1.11±0.42)points],and the difference was statistically significant(t=11.674,2.484,P<0.05).There was no statistical significance in VAS scores at T0,T2 and T4between the two groups(P>0.05).Compared with the control group at T1 and T3,the VAS scores under exercise in the observation group were lower,and the difference was statistically significant(t=13.784,15.818,P<0.001).There was no statistically significant difference in quadriceps muscle strength rating at T0 between 2 groups(P>0.05).The quadriceps muscle strength rating of control group at T1,T2,T3 and T4 was lower than that of observation group,and the difference was statistically significant(P<0.05).Conclusion The application of ultrasound-guided peripheral hip capsule nerve block in preoperative analgesia in elderly patients with hip fracture can improve the pain sensation and quadriceps muscle strength.