超声引导下连续髂筋膜间隙阻滞超前镇痛在老年股骨颈骨折患者中的应用

Application of Preemptive Analgesia with Ultrasound-guided Continuous Fascia Iliaca Compartment Block in Elderly Patients with Femoral Neck Fracture

目的:探讨超声引导下连续髂筋膜间隙阻滞(UCFICB)在老年股骨颈骨折患者行超前镇痛的舒适度和有效性,并从相关应激炎症因子血清白介素-6(IL-6)和脑源性神经营养因子(BDNF)角度客观评价其效果。方法:选择赣州市人民医院2022年1—12月全身麻醉下行单侧全髋关节置换术患者60例,采用随机数字表法将患者分为两组:试验组(n=30,入院后行超声引导下连续髂筋膜间隙阻滞超前镇痛)和对照组(n=30,常规静脉自控镇痛)。比较两组患者不同时间点疼痛感受、精神状况、外周血IL-6和BDNF水平,以及术中阿片类药物消耗情况。结果:两组入院即刻静息状态下和运动时的视觉模拟评分法(VAS)评分比较,差异均无统计学意义(P>0.05);术后24、48 h,与对照组相比,试验组静息和运动状态下VAS评分均低,差异均有统计学意义(P<0.05)。试验组手术中舒芬太尼、瑞芬太尼消耗总量均少于对照组,差异均有统计学意义(P<0.05)。两组入院时的简易精神状态评价量表(MMSE)评分差异无统计学意义(P>0.05);术后24、72 h,试验组MMSE评分均高于对照组,差异均有统计学意义(P<0.05)。与对照组相比,试验组术毕、术后24 h的IL-6水平均较低,BDNF水平均较高,差异均有统计学意义(P<0.05)。结论:超声引导下连续髂筋膜间隙阻滞超前镇痛应用于老年股骨颈骨折患者,能够缓解围手术期疼痛,减少镇痛药物的使用,降低围手术期炎症应激反应,改善患者认知。

Objective:To investigate the comfort and effectiveness of ultrasound-guided continuous fascia iliaca compartment block(UCFICB)in advanced analgesia in elderly patients with femoral neck fracture,and objectively evaluate its effects from the perspective of serum interleukin-6(IL-6)and brain-derived neurotrophic factor(BDNF).Method:A total of 60 patients undergoing unilateral total hip arthroplasty under general anesthesia were selected from Ganzhou People's Hospital from January to December 2022,the patients were divided into two groups by random number table method:experimental group(n=30,preemptive analgesia with ultrasound-guided continuous fascia iliaca compartment block)and control group(n=30,routine intravenous self-controlled analgesia).Pain perception,mental status,peripheral blood IL-6 and BDNF levels at different time points,and intraoperative opioid consumption were compared between the two groups.Result:There were no significant differences in visual analogue score(VAS)between the two groups immediately after admission and during exercise(P>0.05);24 and 48 h after surgery,VAS scores at rest and exercise in experimental group were lower than those in control group,the differences were statistically significant(P<0.05).The total consumption of Sufentanil and Remifentanil in experimental group were less than those in control group,the differences were statistically significant(P<0.05).There was no significant difference in MMSE score between the two groups at admission(P>0.05);24 and 72 h after surgery,MMSE scores in experimental group were higher than those in control group,the differences were statistically significant(P<0.05).Compared with the control group,the experimental group had lower levels of IL-6 and higher levels of BDNF in the postoperative and 24 h postoperative,the differences were statistically significant(P<0.05).Conclusion:The application of ultrasound-guided continuous fascia iliaca compartment block advanced analgesia in elderly patients with femoral neck fracture can alleviate perioperative pain,reduce the use of analgesic drugs,reduce perioperative inflammatory stress response,improve patients'cognition.