[1]何旭秀,韩 娟.超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞在老年髋部骨折患者麻醉镇痛中的应用研究[J].陕西医学杂志,2023,52(6):714-718.[doi:DOI:10.3969/j.issn.1000-7377.2023.06.017]
　HE Xuxiu,HAN Juan.Application of ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block in anesthesia and analgesia of elderly patients with hip fractures[J].,2023,52(6):714-718.[doi:DOI:10.3969/j.issn.1000-7377.2023.06.017]
点击复制

超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞在老年髋部骨折患者麻醉镇痛中的应用研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年6期
页码:
714-718
栏目:
临床研究
出版日期:
2023-06-05

文章信息/Info

Title:
Application of ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block in anesthesia and analgesia of elderly patients with hip fractures
作者:
何旭秀1; 韩 娟2
(1.青海省中医院麻醉科,青海 西宁 810099; 2.青海省中医院手术室,青海 西宁 810099)
Author(s):
HE Xuxiu; HAN Juan
(Department of Anesthesiology,Qinghai Provincial Hospital of Traditional Chinese Medicine,Xining 810099,China)
关键词:
髋部骨折;  超声引导;  高位髂筋膜间隙阻滞;  骶丛阻滞;  血流动力学;  认知功能
Keywords:
Hip fractures;  Ultrasonic guidance;  High fascia iliaca compartment block;  Sacral plexus block;  Hemodynamics;  Cognitive function
分类号:
R 683.3
DOI:
DOI:10.3969/j.issn.1000-7377.2023.06.017
文献标志码:
A
摘要:
目的:分析超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞在老年髋部骨折患者麻醉镇痛中的应用价值。方法:选取老年髋部骨折患者80例,按入院顺序编号,根据单双号法分为全麻组(全凭静脉麻醉组)和联合阻滞组(全凭静脉麻醉+超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞),各40例。记录术中麻醉药物用量、术后24 h静脉自控镇痛(PCIA)用药量及麻醉苏醒时间。比较两组在入室时(T0)、插管(T1)、手术开始5 min(T2)、手术结束时(T3)的心率(HR)及平均动脉压(MAP)。比较两组拔管30 min和出恢复室时的Ramsay镇静评分。比较两组术后3、6、12、24 h静息时视觉模拟量表(VAS)评分。比较术前及术后24、48、72 h简易智力状态检查量表(MMSE)评分及认知障碍发生率。记录两组不良反应发生情况。结果:联合阻滞组麻醉药物(舒芬太尼、丙泊酚)用量和术后24 h静脉自控镇痛用药量低于全麻组,麻醉苏醒时间短于全麻组(均P<0.05)。HR及MAP组间、时间及交互比较差异有统计学意义(均P<0.05)。联合阻滞组在T2、T3时HR和MAP高于全麻组(均P<0.05)。拔管30 min时,联合阻滞组Ramsay镇静评分显著低于全麻组(P<0.05)。出恢复室时,两组间Ramsay镇静评分比较差异无统计学意义(P>0.05)。VAS评分组间、时间及交互比较差异有统计学意义(均P<0.05)。联合阻滞组在术后3、6、12 h时VAS评分显著低于全麻组(均P<0.05)。两组MMSE评分随术后时间延长,呈先下降后升高趋势,且联合阻滞组术后各时间点显著高于全麻组(均P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论:超声引导下高位髂筋膜间隙阻滞联合骶丛阻滞应用于老年髋部骨折患者镇痛效果好,能有效减少麻醉药物用量,对认知功能损伤小。
Abstract:
Objective:To analyze the application value of ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block in the anesthesia and analgesia of elderly patients with hip fractures.Methods:Eighty elderly patients with hip fractures were selected and numbered according to the order of admission,and then they were randomly divided into general anesthesia group(total intravenous anesthesia group)and combined block group(total intravenous anesthesia plus ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block)by single-double number method,with 40 cases in each group.The consumption of intraoperative anesthetic drugs,dosage of patient-controlled intravenous analgesia(PCIA)within 24 hours after surgery and recovery time from anesthesia were recorded.The HR and MAP were compared between two groups at the time of entering the operating room(T0),the time of intubation(T1),5 minutes after the beginning of the surgery(T2)and the end of the surgery(T3).Ramsay scores were compared between the two groups at 30 minutes after extubation and when leaving the recovery room.The VAS scores at rest were compared between the two groups at 3,6,12 and 24 hours after operation.The MMSE score and the incidence of cognitive impairment were compared before operation and 24,48,72 hours after operation.The adverse reactions of the two groups were recorded.Results:Compared with the general anesthesia group,the consumption of sufentanil and propofol and the dosage of patient-controlled intravenous analgesia within 24 hours after operation in the combined block group were lower,and the recovery time from anesthesia was shorter(all P<0.05).There were significant differences in HR and MAP between groups,time and interaction(all P<0.05).HR and MAP in the combined block group were higher than those in the general anesthesia group at T2 and T3(all P<0.05).At 30 minutes after extubation,Ramsay score in the combined block group was significantly lower than that in general anesthesia group(P<0.05).There was no significant difference in Ramsay score between the two groups at the time of leaving the recovery room(P>0.05).There were statistically significant differences in VAS scores between groups,time and interaction(all P<0.05).The VAS scores at 3,6 and 12 hours after operation in the combined block group were significantly lower than those in the general anesthesia group(all P<0.05).The MMSE scores of the two groups decreased first and then increased with the extension of postoperative time,and the MMSE scores of the combined block group were significantly higher than those of the general anesthesia group at each time point after operation(all P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided high fascia iliaca compartment block combined with sacral plexus block has a good analgesic effect in elderly patients with hip fracture,which can effectively reduce the dosage of anesthetic drugs and has little damage to cognitive function.

参考文献/References:

[1] 刘建宇,李宏伟,张 彦.人工关节置换或动力髋螺钉内固定术后应用阿仑膦酸钠对老年股骨骨折患者骨密度的影响[J].中国药业,2020,29(22):72-74.
[2] 刘宏飞,霍鹏伟.超声引导下腰丛-坐骨神经阻滞与硬膜外麻醉用于老年膝关节置换术对比研究[J].陕西医学杂志,2020,49(8):947-950.
[3] 谢娟华,赵姣姣,刘枧辉,等.超声引导髂筋膜阻滞联合单侧腰椎麻醉在老年股骨骨折手术中的应用[J].海南医学,2021,32(15):1998-2001.
[4] 肖 瑛,鲁应军.超声引导髂筋膜间隙阻滞联合骶丛神经阻滞复合喉罩全麻在老年髋关节置换术中的应用效果观察[J].贵州医药,2021,45(7):1054-1055.
[5] Waterfield J,Sim J.Clinical assessment of pain by the visual analogue scale[J].Br J Ther Rehabil,2013,3(2):94-97.
[6] Erdogan O,Celik MG,Kocoglu H,et al.Correlation between ramsay sedation scale and richmond agitation-sedation scale with bispectral index montoring in the intensive care unit[J].ARC Journals,2018,3(1):3-8.
[7] Kasamaki K,Kobayashi S,Kato A,et al.Long term change in the mini-mental state examination(MMSE)in Alzheimer's disease:Factors associated with heterogeneity of slowly progressive patients[J].Clinical Psychiatry,2017,59(8):759-768.
[8] 黄菲菲,朱建炜,徐春香,等.老年髋关节置换术后髋关节疼痛及生活质量的影响因素[J].中国老年学杂志,2022,42(16):4089-4092.
[9] 李 楠,刘丹平.微创Supercap入路半髋关节置换术与全髋关节置换术治疗老年股骨颈骨折效果对比研究[J].陕西医学杂志,2021,50(3):315-318.
[10] 于继洋,孙旭东,祝勇刚.人工关节置换术治疗老年髋臼骨折疗效及对患者血清炎性指标、骨代谢水平的影响[J].陕西医学杂志,2022,51(4):419-423.
[11] 王雯霞,马龙先.超声引导下髂筋膜间隙联合骶丛神经阻滞在老年全髋关节置换术中的应用[J].临床麻醉学杂志,2017,33(10):953-956.
[12] 邓亚南,潘小妮,刘 鑫,等.针刺与腰丛神经阻滞在全髋关节置换术患者超前镇痛中的应用比较[J].陕西中医,2022,43(10):1455-1458.
[13] 李林锋,郑传东,李 强,等.超声引导髂筋膜间隙阻滞联合骶丛神经阻滞复合喉罩全麻在老年髋关节置换术中的应用[J].实用医院临床杂志,2020,17(4):57-59.
[14] 胡 婕,汪 欢,陈士寿,等.超声引导下“领结征”髂筋膜联合骶丛神经阻滞应用于人工髋关节置换术的效果[J].实用医学杂志,2021,37(6):763-767.
[15] 音 樱,章 敏,疏树华,等.超声引导下改良髂筋膜间隙阻滞在老年股骨近端骨折麻醉中的应用[J].临床麻醉学杂志,2018,34(7):660-664.
[16] 阮 倩,自华芬,陈 莉.右美托咪定与罗哌卡因腰硬联合麻醉对老年下肢骨折患者围术期血流动力学、麻醉恢复质量及镇痛效果的影响[J].川北医学院学报,2021,36(8):1068-1071.
[17] 罗声臻,潘永英,盛福庭,等.超声引导髂筋膜腔隙与髂腹下/髂腹股沟神经复合阻滞在老年患者髋关节置换术术后镇痛中的作用[J].国际麻醉学与复苏杂志,2017,38(6):506-514.
[18] 张 瑶,蔡增彬,宋立公.龙龟安神汤治疗老年人髋部骨折术后谵妄临床研究[J].陕西中医,2021,42(12):1732-1735.
[19] 张炳勇,高 涛.超声引导下行髂筋膜联合腰骶丛神经阻滞和全身麻醉在老年患者髋关节置换术中的对比研究[J].中华老年多器官疾病杂志,2019,18(9):688-692.
[20] 左 东,周 民.超声引导下腰丛联合骶旁坐骨神经阻滞在高龄股骨颈骨折内固定术中的应用[J].创伤外科杂志,2017,19(7):503-507.

相似文献/References:

[1]陆纯德.全髋关节置换治疗髋部复杂性骨折切开复位内固定术后〖JZ〗并发创伤性骨性融合疗效研究[J].陕西医学杂志,2019,(10):1333.
　LU Chunde..Therapeutic effect of THA on secondary traumatic hip arthrodesis after internal fixation[J].,2019,(6):1333.
[2]朱 媛,强 辉,王珍芳,等.超声引导下穿刺减压联合体外冲击波疗法治疗肩袖钙化性肌腱炎短期疗效观察[J].陕西医学杂志,2022,51(3):330.[doi:DOI:10.3969/j.issn.1000-7377.2022.03.015]
　ZHU Yuan,QIANG Hui,WANG Zhenfang,et al.Short-term efficacy of ultrasound-guided puncture decompression combined with extracorporeal shock wave therapy in treatment of rotator cuff calcified tendinitis[J].,2022,51(6):330.[doi:DOI:10.3969/j.issn.1000-7377.2022.03.015]
[3]陈 曦,拓胜军,刘丽文,等.超声引导射频消融联合泡沫硬化剂治疗不同临床分级下肢静脉曲张疗效观察[J].陕西医学杂志,2022,51(12):1520.[doi:DOI:10.3969/j.issn.1000-7377.2022.12.012]
　CHEN Xi,TA Shengjun,LIU Liwen,et al.Clinical efficacy of ultrasound-guided radiofrequency ablation combined with foam sclerosing agent in treating varicose veins of lower extremity with different clinical grades[J].,2022,51(6):1520.[doi:DOI:10.3969/j.issn.1000-7377.2022.12.012]
[4]姚 溪,侯敏娜,岳 芳,等.乳腺癌改良根治术患者近端肋间臂神经联合前锯肌平面阻滞临床效果观察[J].陕西医学杂志,2024,(9):1228.[doi:DOI:10.3969/j.issn.1000-7377.2024.09.016]
　YAO Xi,HOU Minna,YUE Fang,et al.Clinical effect of proximal intercostobrachial nerve combined with serratus anterior plane block in patients undergoing modified radical mastectomy for breast cancer[J].,2024,(6):1228.[doi:DOI:10.3969/j.issn.1000-7377.2024.09.016]

备注/Memo

备注/Memo:
基金项目:青海省卫生计生委科研课题(2018-WJZDX-61)
更新日期/Last Update: 2023-06-05