超声引导下高位髂筋膜间隙阻滞联合椎管内麻醉在高龄老年髋部手术中的麻醉效果观察

Observation on the Anesthetic Effect of Ultrasound-guided High Iliac Fascia Block Combined with Intraspinal Anesthesia in Elderly Hip Surgery

目的研究超声引导下高位髂筋膜间隙阻滞(FICB)联合椎管内麻醉在高龄老年髋部手术中的麻醉效果。方法选取2020年1月-2022年3月于泗洪分金亭医院行髋部手术治疗的82例高龄患者,采用随机数字表法分为对照组(41例)和观察组(41例)。对照组应用单独椎管内麻醉,观察组应用超声引导下高位FICB联合椎管内麻醉,比较两组神经阻滞前(T0)、神经阻滞后(T1)、转运床上搬运后(T2)、摆放侧卧位时(T3)、椎管内麻醉后(T4)的疼痛视觉模拟评分(VAS)与血流动力学指标[平均动脉压(MAP)、心率(HR)],以及术后VAS评分、麻醉相关并发症。结果观察组T1、T2、T3、T4 VAS评分均低于对照组(P<0.05);观察组T1、T2、T3、T4的MAP、HR指标与T0时MAP、HR指标比较,差异无统计学意义(P>0.05);对照组T1、T2、T3、T4的MAP、HR指标与T0时MAP、HR指标比较,差异有统计学意义(P<0.05);两组T1、T2、T3、T4 MAP、HR指标比较,差异有统计学意义(P<0.05);观察组术后4、12、24 h VAS评分均低于对照组(P<0.05);观察组麻醉相关并发症发生率小于对照组(P<0.05)。结论超声引导下高位FICB联合椎管内麻醉在高龄患者髋部手术中具有确切应用价值,其麻醉效果理想,且血流动力学影响较小,术后并发症少,有利于术后快速康复。

Objective To study the anesthetic effect of ultrasound-guided high fascia iliac block(FICB)combined with spinal anesthesia in elderly hip surgery.Methods A total of 82 elderly patients who underwent hip surgery in Sihong Fenjinting Hospital from January 2020 to March 2022 were selected and divided into control group(41 patients)and observation group(41 patients)by random number table method.The control group was treated with intraspinal anesthesia alone,and the observation group was treated with ultrasound-guided high FICB combined with intraspinal anesthesia.The pain visual analogue scale(VAS)and hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR)]before nerve block(T0),after nerve block(T1),after transport on the transfer bed(T2),during lateral position(T3),and after intraspinal anesthesia(T4),as well as postoperative VAS score and anesthesia-related complications were compared between the two groups.Results The VAS scores at T1,T2,T3 and T4 in the observation group were lower than those in the control group(P<0.05).There was no significant difference in MAP and HR between T1,T2,T3,T4 and T0 in the observation group(P>0.05).The MAP and HR indexes at T1,T2,T3 and T4 in the control group were significantly different from those at T0(P<0.05).There were significant differences in MAP and HR between the two groups at T1,T2,T3 and T4(P<0.05).The VAS scores of the observation group at 4,12 and 24 h after operation were lower than those of the control group(P<0.05).The incidence of anesthesia-related complications in the observation group was lower than that in the control group(P<0.05).Conclusion Ultrasound-guided high FICB combined with intraspinal anesthesia has a definite application value in hip surgery in elderly patients.The anesthetic effect is ideal,and the hemodynamic effect is small,with fewer postoperative complications,which is conducive to rapid postoperative recovery.