摘要
目的:探讨股神经阻滞和舒芬太尼用于髋部骨折患者蛛网膜下隙阻滞前摆放体位时的镇痛效果。方法髋部骨折患者60例,随机分为对照组(C 组)、股神经阻滞组(F 组)和舒芬太尼组(S 组),每组20例。F 组超声引导下0.5%罗哌卡因20ml 行股神经阻滞,S 组静脉给予0.15μg/kg舒芬太尼,C 组不做任何处理。记录患者入室时(T0)、摆放体位前(T1)、摆放体位时(T2)的 MAP、HR、SpO2,T1时改良 OAA /S 评分,T2时 VAS 评分,测定 T0、T2血浆去甲肾上腺素(NA)、皮质醇浓度(Cor),记录不良反应。结果与 T0比较,C 组 T2时 MAP、HR 及血浆 NA、Cor 均升高(P <0.05),F组 T2时 MAP、HR 及血浆 NA、Cor 未见明显升高(P >0.05),S 组 T2时 MAP、HR 及血浆 Cor 升高不明显(P >0.05),但血浆 NA 显著升高(P <0.05);组间比较三组各时点 MAP、HR、SpO2和血浆NA、Cor 差异均无统计学意义(P >0.05);与 C、F 组比较,S 组改良 OAA/S 评分升高(P <0.05);F组和 S 组 VAS 评分均显著低于 C 组(P <0.05),F 组与 S 组比较差异无统计学意义(P >0.05);C 组和 F 组未发生不良反应,S 组发生呼吸抑制3例,恶心呕吐1例,眩晕1例。结论两者都可明显缓解髋部骨折患者摆放体位时的疼痛,镇痛效果几乎一致,股神经阻滞更能抑制疼痛引起的应激反应。
Objective To observe and compare the analgesic efficacy of femoral nerve block (FNB)and sufentanil for positioning patients with fractured hip.Methods Sixty patients scheduled for hip fracture surgery were randomized into three groups.Fifteen minutes before positioning for subarachnoid block,the FNB group received nerve ultrasound guided FNB using 20 ml ropivacaine 0.5% .Five minutes before positioning,the S group received a dose of IV sufentanil 0.15μg/kg,the C group didn't accept any intervention.The visual analog scale(VAS)following positioning (T2 ),OAA /S scale before positioning (T1 ),MAP,HR,SpO2 entering operating room (T0 )and T1 ,T2 ,adverse reactions were recorded.The plasma concentration of noradrenaline(NA)and cortisol(Cor)by T0 and T2 were measured.Results MAP,HR,the level of NA,Cor by T2 in group C increased significantly by comparing with T0 (P <0.05),while there were no obvious change in group F,and the same to group S except NA.The obvious change of SpO2 couldn't be found at each time point in every group(P >0.05).There were no significant differences in MAP,HR,the level of NA,Cor in all instances among the three groups(P >0.05).The OAA /S of S group was higher than the other groups(P <0.05).Compared with group C,group F and S showed markedly lower VAS at T2 (P <0.05),there were no significant differences between the two group.Side effects of group S included respiratory depression in 3 patients,nausea vomiting in 1 and dizzy in 1,no adverse reaction were found in other groups.Conclusions Both FNB and intravenous sufentanil can reduce the pain of positioning patients with fractured hip,showing almost the same analgesic efficacy,FNB can more inhibit stress reaction caused by pain.
出处
《中国医师杂志》
CAS
2016年第S1期15-18,共4页
Journal of Chinese Physician
关键词
股神经阻滞
舒芬太尼
髋部骨折
镇痛
Femoral nerve block
Sufentanil
Hip fracture
Analgesic