“山坡征”髂筋膜阻滞联合蛛网膜下腔阻滞对老年股骨粗隆间骨折患者的影响

Effect of"Hillside sign"-based Fascia Iliaca Compartment Block Combined with Subarachnoid Block in Elderly patients with Intertrochanteric Fracture of the Femur

目的:探讨“山坡征”髂筋膜阻滞联合蛛网膜下腔阻滞对老年股骨粗隆间骨折患者术后的影响。方法:选取2022年1月—2023年5月于淮安市第二人民医院行股骨近端防旋髓内钉治疗的老年股骨粗隆间骨折患者60例作为研究对象,采用随机数字表法分为超声引导下“山坡征”髂筋膜阻滞联合蛛网膜下腔阻滞组(F组)和蛛网膜下腔阻滞组(S组),各30例。对比两组不良反应发生情况、术后指标、视觉模拟评分法评分及匹兹堡睡眠质量指数评估。结果:F组不良反应发生率低于S组,差异有统计学意义(P<0.001);F组术后首次下床时间、首次经静脉患者自控镇痛按压时间优于S组,差异有统计学意义(P<0.05);翻身实施腰麻前、术后4 h、术后12 h、术后24 h,F组视觉模拟评分法评分低于S组,差异有统计学意义(P<0.05);术后1 d、术后2 d,F组匹兹堡睡眠质量指数评分低于S组,差异有统计学意义(P<0.001)。结论:“山坡征”髂筋膜阻滞联合蛛网膜下腔阻滞对老年股骨粗隆间骨折患者术后镇痛效果好,能够改善围术期睡眠质量,并且具有较高的安全性,有助于患者的快速康复。

Objective:To investigate the influence of Fascia Iliaca compartment Block combined with subarachnoid block on elderly patients with intertrochanteric femoral fractures.Methods:60 cases of elderly patients with intertrochanteric femur fracture who un⁃derwent the surgery of proximal femoral nail antirotation in Huai'an Second People's Hospital from January 2022 to May 2023 were selected for the study,and were classified into the group of ultrasound-guided hillside-sign Fascia Iliaca block(Group F)and sub⁃arachnoid block(Group S),each with 30 cases.The incidence of adverse reactions,postoperative indexes,visual analog scale score and Pittsburgh Sleep Quality Index assessment were compared between the two groups.Results:the incidence of adverse reactions in group F was lower than that in group S,and the difference was statistically significant(P<0.001);the begin time of off-bed activi⁃ties and the begin time of self-controlled transvenous analgesic pump in group F were shorter than those in group S,and the differ⁃ence was statistically significant(P<0.05);the scores of visual analog scoring when patients turns over in group F were lower than those of group S at the following time point:before the anesthesia,4-hour,12-hour and 24-hour after the surgery,and the difference was statistically significant(P<0.05);the Pittsburgh Sleep Quality Index scores of group F were lower than those of group S one-day and two-day after the surgery,and the difference was statistically significant(P<0.001).Conclusion:"Hillside sign"fascia iliaca compartment Block combined with subarachnoid block is effective as postoperative analgesia in elderly patients with intertrochanter⁃ic femur fracture,improves their sleep quality,and has a high degree of safety,which contributes to the rapid recovery of patients.