超声引导下连续髂筋膜阻滞对老年患者全髋关节置换术后早期恢复质量的影响

Effect of ultrasound-guided continuous fascia iliaca compartment block on quality of early recovery after total hip arthroplasty in elderly patients

目的探讨超声引导下连续髂筋膜阻滞(continuous fascia iliac compartment block,CFICB)对老年患者全髋关节置换术后早期恢复质量的影响。方法选取2022年1月至7月于嘉兴学院附属第二医院行全髋关节置换术的老年患者,根据随机数字表法将患者分为CFICB组和患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)组,每组各34例。采用15项恢复质量量表(15-item quality of recovery questionnaire,QoR-15)评估两组患者术后24h和48h的恢复情况。记录两组患者术后1h、3h、6h、12h、24h和48h静息和运动时疼痛数字评分量表(numerical rating scale,NRS)评分和曲线下面积(area under the curve,AUC)及首次镇痛补救时间、镇痛补救发生率、首次下床活动时间、术后住院时间及不良反应发生情况。结果术后24h和48h,CFICB组患者的QoR-15总分及身体舒适度、情绪状态、心理支持、疼痛评分均显著高于同期PCIA组(P<0.05),但两组患者的身体独立评分比较差异均无统计学意义(P>0.05)。术后1h、3h、6h、12h和24h,CFICB组患者的静息和运动时NRS评分均显著低于PCIA组(P<0.05);术后48h,CFICB组患者的运动时NRS评分显著低于PCIA组(P<0.05),但两组患者的静息时NRS评分比较差异无统计学意义(P>0.05)。CFICB组患者术后静息和运动时NRS评分的AUC均显著小于PCIA组,首次镇痛补救时间长于PCIA组,镇痛补救发生率、术后恶心呕吐发生率低于PCIA组(P<0.05)。结论超声引导下CFICB能够提高老年患者全髋关节置换术后早期的恢复质量,并提供良好的镇痛效果。

Objective To investigate the influence of ultrasound-guided continuous fascia iliac compartment block(CFICB)on the quality of early recovery after total hip arthroplasty in elderly patients.Methods Elderly patients undergoing total hip arthroplasty at the Second Affiliated Hospital of Jiaxing University from January to July 2022 were selected.Patients were divided into CFICB group and patient-controlled intravenous analgesia(PCIA)group according to random number table method,34 cases in each group.The 15-item quality of recovery questionnaire(QoR-15)was used to evaluate the recovery of the two groups at 24h and 48h after surgery.Numerical rating scale(NRS)scores at 1h,3h,6h,12h,24h and 48h after resting and exercise and area under the curve(AUC),time of the first analgesic rescue,the incidence of analgesic rescue,the time of first getting out of bed,the time of postoperative hospitalization and the incidence of adverse effect were recorded in both groups.Results At 24h and 48h after surgery,the total score of QoR-15,physical comfort,emotional state,psychological support and pain scores of patients in CFICB group were significantly higher than those in PCIA group(P<0.05),but there were no statistically significant differences in physical independent scores between the two groups(P>0.05).At 1h,3h,6h,12h and 24h after surgery,the NRS scores at rest and exercise in CFICB group were significantly lower than those in PCIA group(P<0.05).At 48h after surgery,the NRS score at exercise in CFICB group was significantly lower than that in PCIA group(P<0.05),but there was no significant difference in resting NRS scores between the two groups(P>0.05).The AUC of NRS scores at rest and exercise in CFICB group were significantly lower than those in PCIA group,the time of first analgesic rescue was longer than that in PCIA group,and the incidence of analgesic rescue and postoperative nausea and vomiting were lower than those in PCIA group(P<0.05).Conclusion Ultrasound-guided CFICB can improve the quality of early recovery after total hip arthroplasty in elderly patients and provide a good analgesic effect.