腹股沟韧带上髂筋膜阻滞联合经静脉患者自控镇痛在老年髋关节置换术后的应用
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作者Author单位AddressE-Mail
姚富 YAO Fu 四川省骨科医院麻醉科, 四川 成都 610041 Sichuan Provincial Orthopaedic Hospital, Chengdu 640041, Sichuan, China bijin2081070@163.com 
税云华 SHUI Yun-hua 四川省骨科医院麻醉科, 四川 成都 610041 Sichuan Provincial Orthopaedic Hospital, Chengdu 640041, Sichuan, China  
向继林 XIANG Ji-lin 四川省骨科医院麻醉科, 四川 成都 610041 Sichuan Provincial Orthopaedic Hospital, Chengdu 640041, Sichuan, China  
杨波 YANG Bo 四川省骨科医院麻醉科, 四川 成都 610041 Sichuan Provincial Orthopaedic Hospital, Chengdu 640041, Sichuan, China  
期刊信息:《中国骨伤》2024年,第37卷,第5期,第482-487页
DOI:10.12200/j.issn.1003-0034.20220753
基金项目:
中文摘要:

目的:比较经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)与腹股沟韧带上髂筋膜阻滞联合PCIA在老年髋关节置换术后的应用效果。

方法:2019年6月至2021年6月84例老年患者接受髋关节置换术,其中42例以PCIA镇痛作为对照组,男18例,女24例;年龄60~78(70.43±3.67)岁;股骨颈骨折28例,股骨头坏死14例;另42例以腹股沟韧带上髂筋膜阻滞联合PCIA镇痛作为研究组,男20例,女22例;年龄61~76(69.68±3.74)岁;股骨颈骨折25例,股骨头坏死17例。分别于术后2、6、12、24、48 h进行疼痛视觉模拟评分(visual analogue scale,VAS)及Ramesay镇静评分。观察比较两组术后48 h的舒芬太尼总消耗量、PCIA总按压次数、术后首次下地时间、住院时间、不良反应发生率、镇痛满意度等随访结果。

结果:两组术后随访9~24(13.85±2.67)个月。两组手术时间和术中出血量比较,差异无统计学意义(P>0.05)。两组术后2 h的VAS比较,差异无统计学意义(P>0.05),研究组术后6、12、24、48 h的VAS均低于对照组(P<0.05)。研究组术后2、6、12 h的Ramesay镇静评分均高于对照组(P<0.05),两组术后24、48 h的Ramesay评分比较差异无统计学意义(P>0.05)。研究组术后48 h内舒芬太尼消耗量、PICA按压次数少于对照组(P<0.05),术后首次下地时间早于对照组(P<0.05)。研究组镇痛满意度高于对照组(P<0.05)。两组住院时间、不良反应发生率、随访期间并发症比较差异无统计学意义(P>0.05)。

结论:腹股沟韧带上髂筋膜阻滞联合PCIA在老年髋关节置换术后镇痛和镇静效果显著,可减少舒芬太尼使用量及PCIA总按压次数,有利于患者早期下床活动,提高镇痛满意度。
【关键词】腹股沟韧带  髂筋膜阻滞  经静脉自控镇痛  老年人  髋关节置换术
 
Application of superior iliac fascia block of inguinal ligament combined with patient controlled intravenous analgesia in elderly patients after hip arthroplasty
ABSTRACT  

Objective To compare the effect of patient-controlled intravenous analgesia(PCIA) and superior inguinal ligament iliac fascia block combined with PCIA after hip replacement in the elderly.

Methods Total of 82 elderly patients were treated with hip arthroplasty from June 2019 to June 2021 and randomly divided into observation group and control group. There were 42 patients in control group,including 18 males and 24 females,aged from 60 to 78 years old with an average of (70.43±3.67) years old,28 femoral neck fractures and 14 femoral head necrosis,who received PCIA. The study group consisted of 42 cases,including 20 males and 22 females,aged from 61 to 76 years old with an average of (69.68±3.74) years old,25 femoral neck fractures and 17 femoral head necrosis,who received superior inguinal ligament iliac fascia block combined with PCIA. Pain visual analogue scale (VAS) and Ramesay sedation scores at 2 h,6 h,12 h,24 h and 48 h after operation were evaluated. In addition,the follow-up results of the total consumption of sufentanil and the total number of PCIA compressions at 48 hours after operation,the first time of landing after surgery,the time of hospital stay,the incidence of adverse reactions,the satisfaction with analgesia of two groups were observed.

Results All patients were followed up for 9 to 24 months with an average of(13.85±2.67) months. There was no significant difference in operation time and intraoperative bleeding between two groups (P>0.05). There was no difference in VAS between two groups at 2 hours after operation (P>0.05),and the VAS of the study group at 6 h,12 h,24 h and 48 h after operation were lower than those of the control group(P<0.05). The Ramesay sedation scores of the study group at 2 h,6 h and 12 h after operation were higher than those of the control group(P<0.05),and there were no differences in Ramesay score between two groups at 24 h and 48 h after operation (P>0.05). The consumption of sufentanil in the study group within 48 hours after operation was lower than that in the control group (P<0.05),and PCIA compression times were lower than those in the control group(P<0.05),and the time of first landing was earlier than that in the control group(P<0.05). There was no significant difference in hospital stay,adverse reaction rate,complications between two groups (P>0.05). The satisfaction of analgesia in the study group was higher than that in the control group (P<0.05).

Conclusion Superior iliac fascia block of inguinal ligament combined with PCIA has significant analgesic and sedative effects after hip arthroplasty in the elderly. It can reduce the amount of sufentanil used and the total number of PCIA compressions,which is conducive to the early activity of patients out of bed,improve the satisfaction of analgesia.
KEY WORDS  Inguinal ligament  Iliac fascia block  Patient controlled intravenous analgesia  Elderly  Hip arthroplasty
 
引用本文,请按以下格式著录参考文献:
中文格式:姚富,税云华,向继林,杨波.腹股沟韧带上髂筋膜阻滞联合经静脉患者自控镇痛在老年髋关节置换术后的应用[J].中国骨伤,2024,37(5):482~487
英文格式:YAO Fu,SHUI Yun-hua,XIANG Ji-lin,YANG Bo.Application of superior iliac fascia block of inguinal ligament combined with patient controlled intravenous analgesia in elderly patients after hip arthroplasty[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(5):482~487
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