超声引导下高位髂筋膜间隙阻滞对老年髋部骨折手术患者麻醉及镇痛效果的影响

Effect of ultrasound-guided high-position fascia iliaca compartment block on anesthesia and analgesia in older adult patients undergoing hip fracture surgery

目的观察超声引导下高位髂筋膜间隙阻滞(FICB)对老年髋部骨折手术患者麻醉及镇痛效果。方法选择2022年1月至2023年10月东阳市人民医院骨科收治的老年髋部骨折手术患者120例为研究对象,采用前瞻性对照研究方法,按照随机数字表法分成常规组与高位组,常规组(60例)于入手术室前30 min行超声引导下常规FICB,高位组(60例)于入手术室前30 min行超声引导下高位FICB。观察两组的神经阻滞起效时间(股神经、股外侧皮神经、闭孔神经)、不同时间点[神经阻滞前(T0)、入手术室时(T1)、摆放麻醉体位时(T2)、麻醉完成后(T3)]的血流动力学指标(心率、平均动脉压)、疼痛程度[视觉模拟评分法(VAS)评分]变化情况,神经阻滞前(T0)、麻醉完成后(T3)的疼痛递质指标(前列腺素E2、5-羟色胺)变化情况。结果高位组股神经、股外侧皮神经、闭孔神经的起效时间均短于常规组[(4.02±1.16)min、(4.55±1.29)min、(7.71±2.02)min比(5.15±1.42)min、(6.62±1.78)min、(12.24±3.68)min](t=4.77、7.29、8.35,均P<0.001);高位组T1、T2的心率、平均动脉压均高于常规组[(77.55±9.19)次/min、(75.54±9.37)次/min、(95.62±10.51)mmHg(1 mmHg=0.133 kPa)、(92.72±11.44)mmHg比(74.62±9.68)次/min、(72.41±9.36)次/min、(92.36±10.04)mmHg、(88.24±11.35)mmHg](t=1.70、1.82、1.73、2.15,P=0.046、0.035、0.042、0.017);高位组T1、T2的VAS评分均低于常规组[(3.05±0.61)分、(3.44±0.89)分比(3.72±0.67)分、(4.29±1.06)分](t=5.73、4.76,均P<0.001);高位组T3的前列腺素E2、5-羟色胺均低于常规组[(35.38±6.12)mg/L、(0.59±0.09)μmol/L比(44.91±6.72)mg/L、(0.63±0.13)μmol/L](t=8.12、1.96,P<0.001、P=0.026)。结论超声引导下高位FICB在老年髋部骨折手术患者麻醉中的应用效果较好,能够缩短神经阻滞起效时间,稳定血流动力学指标,减轻疼痛。

Objective To investigate the anesthetic and analgesic effects of ultrasound-guided high-position fascia iliaca compartment block(FICB)in older adult patients undergoing hip fracture surgery.Methods A total of 120 older adult patients who underwent hip fracture surgery at the Department of Orthopedics,Dongyang People's Hospital,between January 2022 and October 2023,were enrolled in this study.This is a prospective controlled study.The patients were randomly assigned to either a conventional group or a high-position group,with 60 patients in each group,using a random number table method.The patients in the conventional group received ultrasound-guided routine FICB 30 minutes before entering the operating room,whereas the patients in the high-position group underwent ultrasound-guided high-position FICB 30 minutes prior to entering the operating room.The onset time of nerve block in both groups was observed,specifically targeting the femoral nerve,lateral femoral cutaneous nerve,and obturator nerve.Changes in hemodynamic indicators,including heart rate and mean arterial pressure,were monitored at various time points:before nerve block(T0),upon entering the operating room(T1),during anesthesia positioning(T2),and after anesthesia completion(T3).The pain level was assessed using the Visual Analogue Scale score at the same time points.Changes in pain neurotransmitters prostaglandin E2 and 5-hydroxytryptamine were analyzed at T0 and T3.Results The onset time of the femoral nerve,lateral femoral cutaneous nerve,and obturator nerve in the high-position group[(4.02±1.16)minutes,(4.55±1.29)minutes,(7.71±2.02)minutes]were significantly shorter than those in the conventional group[(5.15±1.42)minutes,(6.62±1.78)minutes,(12.24±3.68)minutes,t=4.77,7.29,8.35,all P<0.001].At T1 and T2,the heart rates in the high-position group[(77.55±9.19)beats/minute,(75.54±9.37)beats/minute]and mean arterial pressures[(95.62±10.51)mmHg(1 mmHg=0.133 kPa),(92.72±11.44)mmHg]were significantly higher than those in the conventional group[(74.62±9.68)beats/minute,(72.41±9.36)beats/minute,(92.36±10.04)mmHg,(88.24±11.35)mmHg,t=1.70,1.82,1.73,2.15,P=0.046,0.035,0.042,0.017].At T1 and T2,the VAS scores of the high-position group[(3.05±0.61)points,(3.44±0.89)points]were significantly lower than those in the conventional group[(3.72±0.67)points,(4.29±1.06)points,t=5.73,4.76,both P<0.001].At T3,the levels of prostaglandin E2 and 5-hydroxytryptamine in the high-position group[(35.38±6.12)mg/L,(0.59±0.09)μmol/L]were significantly lower than those in the conventional group[(44.91±6.72)mg/L,(0.63±0.13)μmol/L,t=8.12,1.96,P<0.001,P=0.026].Conclusion Ultrasound-guided high-position FICB exhibits a favorable application effect in anesthetizing older adult patients undergoing hip fracture surgery.It effectively shortens the onset time of nerve block,stabilizes hemodynamic indicators,and alleviates pain.