FICB联合椎管内麻醉对老年全髋关节置换术患者炎症应激反应和术后恢复的影响

Effect of FICB combined with intraspinal anesthesia on inflammatory stress response and postoperative recovery in elderly patients undergoing total hip arthroplasty

目的 探讨老年全髋关节置换术患者实施髂筋膜间隙阻滞(FICB)联合椎管内麻醉的应用效果。方法 96例行全髋关节置换术老年患者均分为对照组和观察组,对照组患者入室后予以椎管内麻醉,观察组患者入室后先行超声引导下FICB,然后再实施椎管内麻醉,2组患者术后均予以自控静脉镇痛;比较2组患者入室时和椎管内麻醉体位摆放即刻的视觉模拟评分(VAS)、椎管内麻醉操作耗时,比较2组患者镇痛泵首次按压时间、按压次数、补救镇痛率,术后首次下床活动时间、住院时间、术后3 d的Harris髋关节评分和术后并发症;检测2组患者前和术后24 h时的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及IL-8水平。结果 与对照组比较,观察组患者椎管麻醉体位摆放即刻的VAS评分降低(P<0.05),椎管内麻醉操作耗时缩短(P<0.05),医师对体位摆放的满意度提高(P<0.05);与对照组比较,观察组患者镇痛泵首次按压时间延迟(P<0.05),按压次数减少(P<0.05),补救镇痛率降低(P<0.05);与对照组比较,观察组患者术后首次下床活动时间提前(P<0.05),术后住院时间缩短(P<0.05),术后谵妄和恶心呕吐的发生率降低(P<0.05);两组患者术后第3天的Harris评分比较,差异无统计学意义(P>0.05);观察组术后24 h的血清TNF-α、IL-6及IL-8水平较对照组降低(P<0.05)。结论 FICB联合椎管内麻醉能够提高老年全髋关节置换术后镇痛效果,减轻应激反应,利于术后恢复。

Objective To explore the effectiveness of the fascia iliaca compartment block(FICB)combined with intraspinal anesthesia in elderly patients with total hip arthroplasty.Methods A total o f 96 elderly patients with total hip replacement were divided into control and observation groups.The control group was given intraspinal anesthesia after home invasion,and the observation group was subjected to ultrasound-guided FICB,and then intraspinal anesthesia.All the two groups received controlled intravenous analgesia.The immediate visual analog score(VAS)and intraspinal anesthesia operation time-consuming were compared in group 2 patients after entering the room.The first press time,number of press times,salvage analgesia rate,postoperative time of first ambulation,hospital stay,Harris hip score 3 d after surgery,and postoperative complications were compared.Serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and IL-8 levels were measured in group 2 before 24 hours after operation.Results Compared with the control group,the VAS scores in the observation group were reduced immediately(P<0.05).The time-consuming of intraspinal anesthesia operation was shortened(P<0.05).Doctors'satisfaction with body placement was increased(P<0.05).The first press time of the analgesic pump was delayed in the observation group(P<0.05).The number of the presses was reduced(P<0.05).The salvage analgesic rate was reduced(P<0.05).Compared with the control group,the first move of patients after surgery in the observation group were earlier(P<0.05).Postoperative hospital stay was shortened(P<0.05).The rate of delusion and vomiting was decreased after surgery(P<0.05).Comparison of the Harris scores on the third postoperative day in the two groups,there was no statistically significant difference(P>0.05).Serum levels of TNF-α,IL-6,and IL-8 at 24 h in the observation group were reduced compared with the control group(P<0.05).Conclusion FICB combined with intraspinal anesthesia can improve the analgesic effect after total hip arthroplasty in the elderly,reduce the stress response,and facilitate the postoperative recovery.