基于ERAS理念的超声下髂筋膜间阻滞用于老年髋部骨折手术患者的临床观察

Clinical observation of iliac fascia block under ultrasound based on ERAS concept in elderly patients undergoing hip fracture surgery

目的分析基于快速康复外科(ERAS)理念的超声下髂筋膜间隙阻滞(FICB)在老年髋部骨折手术患者中的临床应用价值。方法将2023年1月至2024年1月医院收治的96例老年髋部手术患者按随机数字表法分为观察组与对照组,每组48例。两组均进行围手术期管理。对照组入院后口服塞来昔布,观察组入院后即实施超声下FICB。比较两组手术情况、术后静息及移动疼痛程度、麻醉药物及血管活性药物用量、不良反应情况、住院时间及医疗费用。结果两组手术时间、术中出血量及手术方式比较,差异无统计学意义(P>0.05)。术后30 min观察组静息VAS评分、移动VAS评分均低于对照组,术后24 h观察组静息VAS评分低于对照组,差异有统计学意义(P<0.05)。两组均未使用阿托品。观察组丙泊酚、舒芬太尼用量均低于对照组,使用麻黄碱比例低于对照组,差异有统计学意义(P<0.05)。观察组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。观察组术后住院时间较对照组短,住院费用及总医疗费用均低于对照组,差异有统计学意义(P<0.05)。结论基于ERAS理念的超声下FICB可有效减轻老年髋部手术患者术后疼痛,减少术后麻醉药物及血管活性药物的使用,降低不良反应发生率,并缩短患者住院时间,减少医疗费用。

Objective:To analyze the clinical value of ultrasound-guided iliac fascia space block(FICB)based on the concept of rapid rehabilitation surgery(ERAS)in elderly patients undergoing hip fracture surgery.Methods:From January 2023 to January 2024,96 elderly patients with hip surgery were randomly divided into observation group and control group,with 48 cases in each group.Perioperative management was performed in both groups.The control group was given celecoxib orally after admission,and the observation group was given FICB under ultrasound immediately after admission.The operation situation,the degree of postoperative rest and movement pain,the dosage of narcotic drugs and vasoactive drugs,adverse reactions,hospitalization time and medical expenses were compared between the two groups.Results:There was no significant difference in operation time,intraoperative blood loss and operation mode between the two groups(P>0.05).The resting VAS score and moving VAS score in the observation group were lower than those in the control group 30 min after operation,and the resting VAS score in the observation group was lower than that in the control group 24 h after operation,with statistical significance(P<0.05).Atropine was not used in both groups.The dosage of propofol and sufentanil in the observation group was lower than that in the control group,and the proportion of ephedrine used was lower than that in the control group,with statistical significance(P<0.05).The total incidence of adverse reactions in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).The postoperative hospitalization time of the observation group was shorter than that of the control group,and the hospitalization expenses and total medical expenses were lower than those of the control group,with statistical significance(P<0.05).Conclusion:Ultrasound-guided FICB based on ERAS concept can effectively relieve postoperative pain of elderly patients undergoing hip surgery,reduce the use of postoperative anesthetic drugs and vasoactive drugs,reduce the incidence of adverse reactions,shorten the hospitalization time of patients and reduce medical expenses.