超声引导下髂筋膜间隙阻滞在股骨近端骨折中的应用效果及对血流动力学和术后康复的影响

Application of Ultrasound-guided Fascia Iliaca Compartment Block in Proximal Femoral Fracture and Its Influence on Hemodynamics and Postoperative Rehabilitation

目的:探讨超声引导下髂筋膜间隙阻滞在股骨近端骨折中的应用效果及对血流动力学和术后康复的影响。方法:选择2019年1月—2022年1月于福建医科大学附属福清市医院进行治疗的股骨近端骨折105例患者,根据麻醉方式分为试验组(53例)和对照组(52例),对照组进行腰硬联合麻醉,试验组给予超声引导下髂筋膜间隙阻滞。比较两组阻滞效果、平均动脉圧、心率、疼痛情况、术后康复情况及并发症发生情况。结果:试验组运动阻滞起效时间、感觉阻滞起效时间、运动恢复及感觉恢复时间均早于对照组(P<0.05);术中,试验组心率、平均动脉压均高于对照组,差异均有统计学意义(P<0.05);术后,试验组心率低于对照组,平均动脉压高于对照组,差异均有统计学意义(P<0.05)。术后1 h,两组疼痛评分比较,差异无统计学意义(P>0.05);术后6、12、24 h,试验组疼痛评分均低于对照组(P<0.05);两组完全负重时间、骨折愈合时间比较,差异均无统计学意义(P>0.05),试验组住院时间短于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:股骨近端骨折患者应用超声引导下髂筋膜间隙阻滞效果满意,减轻对患者血流动力学的影响,从而提高患者的舒适度,促进术后康复。

Objective:To study application of ultrasound-guided fascia iliaca compartment block in proximal femoral fracture and its influence on hemodynamics and postoperative rehabilitation.Method:A total of 105 patients with proximal femur fractures who were treated in Fuqing Hospital Affiliated to Fujian Medical University from January 2019 to January 2022 were selected and divided into an experimental group(53 cases)and a control group(52 cases)according to the anesthesia method.The control group received combined lumbar and epidural anesthesia,and the experimental group received ultrasound-guided fascia iliaca compartment block.The blocking effect,arterial pressure,heart rate,pain,postoperative rehabilitation and complications were compared between the two groups.Result:Motor block onset time,sensory block onset time,motor recovery time and sensory recovery time of experimental group were earlier than those of control group(P<0.05).During the surgery,the heart rate and mean arterial pressure of experimental group were higher than those of control group,the differences were statistically significant(P<0.05).After surgery,the heart rate of experimental group was lower than that of control group,and the mean arterial pressure was higher than that of control group,with statistical significance(P<0.05).At 1 h after surgery,there was no significant difference in pain scores between the two groups(P>0.05).The pain scores of experimental groups were lower than those of control group at 6,12,24 h after surgery(P<0.05).There were no significant differences in the total weight-bearing time and fracture healing time between the two groups(P>0.05),and the hospital stay of the experimental group was shorter than that of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:In patients with proximal femoral fracture,the effect of ultrasound-guided fascia iliaca compartment block is satisfactory,which reduces the impact on the hemodynamics of patients,thereby improving the comfort of patients and promoting Medical Innovation of China Vol.21,No.31 November,2024 postoperative rehabilitation.