超声引导下髂筋膜间隙阻滞用于老年患者髋部骨折手术的临床观察

Clinical observation of ultrasound-guided fascia iliaca compartment block for elderly patients with hip fracture surgery

目的探究超声引导下髂筋膜间隙阻滞(fascia iliaca compartment block,FICB)在老年患者髋部骨折手术中的临床应用效果。方法选取开封市人民医院2021年3月—2023年6月间96例老年髋部骨折患者为研究对象,按照简单随机法分为观察组和对照组,各48例,两组均行椎管内麻醉,观察组在椎管内麻醉前行咪达唑仑及地佐辛镇静、镇痛,后经超声引导下进行FICB,对照组在椎管内麻醉前给予咪达唑仑及地佐辛静脉镇静、镇痛,术后均给予自控镇痛(PCA),比较两组围麻醉期血流动力学波动、镇痛[视觉模拟评分法(VAS)]、术后补救镇痛情况、术前1 d及术后6 h应激反应指标[去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)]水平变化及不良反应情况。结果心率(HR)、平均动脉压(MAP)组间比较,差异均具有统计学意义(P<0.05)。两组T1、T2、T3时间点HR、MAP比较,差异有统计学意义(P<0.05);观察组术后2 h、6 h、24 h VAS评分显著低于对照组(P<0.05);观察组术后24 h内PCA次数、有效PCA次数显著低于对照组(P<0.05),镇痛泵首次使用时间显著长于对照组(P<0.05);与术前相比,两组术后6h NE、Cor、AngⅡ水平均显著升高(P<0.05),观察组术后显著低于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下FICB可有效缓解老年髋部骨折手术患者围麻醉期疼痛,减少血流动力学波动,并有效减轻术后应激反应,安全性较高,可在临床推广应用。

Objective To explore the clinical effect of ultrasound-guided fascia iliaca compartment block(FICB)for elderly patients with hip fracture surgery.Methods Totally 96 elderly patients with hip fractures in Kaifeng People's Hospital from March 2021 to June 2023 were selected as the research subjects.According to the simple random method,they were classified into observation group(48 cases)and control group(48 cases).Both groups were given intraspinal anesthesia,and the observation group was given midazolam and dezocine for sedation and analgesia before intraspinal anesthesia and then underwent ultrasound-guided FICB,while the control group was treated with midazolam and dezocine before intraspinal anesthesia and received patient-controlled analgesia(PCA)after surgery.The peri-anesthesia hemodynamic fluctuations,analgesia[visual analogue scale(VAS)],postoperative remedial analgesia status,stress response indicators[norepinephrine(NE),cortisol(Cor),angiotensinⅡ(AngⅡ)]at 1 day before surgery and at 6 hours after surgery and adverse reactions were compared between the two groups.Results There were statistically significant differences in HR and MAP from the aspects of between-group(P<0.05).The HR and MAP revealed statistical differences between the two groups at T1,T2 and T3(P<0.05).The VAS score in observation group at 2,6 and 24 hours after surgery was significantly lower(P<0.05).The number of PCA and the number of effective PCA in observation group were significantly less than those in control group within 24 hours after surgery(P<0.05),and the first use time of analgesia pump was significantly longer compared to control group(P<0.05).Compared with before surgery,the levels of NE,Cor and AngⅡwere significantly increased in the two groups at 6 hours after surgery(P<0.05),and the levels in observation group were significantly lower after surgery(P<0.05).The adverse reactions between the two groups were not statistically different(P>0.05).Conclusion Ultrasound-guided FICB can effectively relieve the peri-anesthesia pain,reduce the hemodynamic fluctuations,and effectively relieve the postoperative stress response in elderly patients with hip fracture surgery.It has high safety and can be promoted for clinical use.