超声引导下2种髂筋膜间隙阻滞方案在老年髋置换术中的镇痛效果和安全性的比较

Analgesia Effect and Safety Comparison of Two Different Ultrasound Fascia Iliaca Compartment Block Guided by Ultrasound in Elderly Patients with Hip Replacement

关键词:  老年髋关节置换术  超声  髂筋膜间隙阻滞镇痛  安全性

Key words:  elderly hip replacement  ultrasound  fascia iliac compartment block analgesia  safety

摘要:

目的 研究超声引导下不同髂筋膜间隙阻滞镇痛（fascia iliaca compartment block，FICB）方案在老年髋关节置换术应用的镇痛效果和安全性。方法 抽选2015年1月-2017年1月丽水市中医院骨科住院部治疗的82例老年髋置换术患者进行研究，根据随机数字法划分组别，对照组（n=41）在超声引导下行单次0.6 mL·kg^-1的0.2%罗哌卡因FICB镇痛，观察组（n=41）在完成单次罗哌卡因髂筋膜间隙注射后置管持续镇痛；统计对比2组不同时间点感觉阻滞情况、疼痛评分及不良反应发生率。结果 T₄、T₅时刻观察组感觉阻滞有效率显著高于对照组，T₅时刻观察组VAS评分明显低于对照组，2组均未见置管相关不良反应，观察组不良反应率显著低于对照组（P<0.05）。其余时刻2组阻滞有效率比较、VAS评分比较均无统计学差异。结论 老年髋置换患者术中采用髂筋膜间隙置管持续阻滞镇痛效果好，无操作相关不良反应，安全性高。

Abstract:

OBJECTIVE To study the analgesia effect and security of ultrasound guided by different fascia iliaca compartment block (FICB) scheme in elderly hip replacement. METHODS Eighty-two cases of elderly patients with total hip arthroplasty in Lishui city hospital of traditional chinese medicine orthopedic inpatient treatment from January 2015 to January 2017 were selected. According to random number method, 82 cases were divided into two groups, the control group (n=41) were guided by ultrasound in FICB with a 0.6 mL·kg^-1 of solution containing 0.2% ropivacaine, observation group (n=41) were received by continuous analgesia ropivacaine after finish the single 0.2% ropivacaine infusiong. Different time points sensory blockade, pain score and the incidence of adverse reactions in two groups were compared. RESULTS Sensory blockade effectiveness of T₄ and T₅ efficient moment in observer group were significantly higher than that in control group. VAS score of T₅ moment in observation group was obviously lower than that in control group. Catheter related adverse reaction of two groups were not found. Adverse reaction rate of observation group was signidicantly lower than that in control group(P<0.05). there were no signidicantly difference between two groups in the rest of the time block efficient comparison and VAS score. CONCLUSION In elderly patients with hip replacement surgery in the iliac fascia clearance catheter continuous block analgesia can ensure patients also get effective postoperative analgesia, no operation related adverse reactions, high safety.