文章摘要
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
Clinical application of modified ultrasound-guided fascia iliaca compartment block for upper femur fractures surgery
  
DOI：10.12089/jca.2018.07.009
中文关键词: 超声  髂筋膜间隙阻滞  全身麻醉  术后镇痛
英文关键词: Ultrasound  Fascia iliaca compartment block  General anesthesia  Postoperative analgesia
基金项目:
作者单位E-mail
音樱 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
章敏 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
疏树华 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
谷海 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
谢言虎 230001,合肥市,中国科学技术大学附属第一医院麻醉科  
徐磊 230001,合肥市,中国科学技术大学附属第一医院骨科  
方诗元 230001,合肥市,中国科学技术大学附属第一医院骨科  
柴小青 230001,合肥市,中国科学技术大学附属第一医院麻醉科 13866716646@163.com 
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中文摘要:
      
目的 观察超声引导下改良髂筋膜间隙阻滞在老年股骨近端骨折手术中的麻醉效果。

方法 选择股骨近端骨折拟行人工股骨头置换术或股骨近端髓内钉手术的老年患者60例, 男 22 例, 女 38 例, 年龄 65～99 岁, BMI 18.6～29.7 kg/m2, ASA Ⅰ-Ⅳ级。采用随机数字表法将其分为两组：单纯全麻组(GA组)和全麻联合神经阻滞组(GB组), 每组30例。两组均给予咪达唑仑、依托咪酯、舒芬太尼及顺式阿曲库铵麻醉诱导后行喉罩全麻,GB组在全麻后, 经超声引导给予0.5% 罗哌卡因30 ml进行改良髂筋膜间隙阻滞。记录入室时(T0)、置入人工气道即刻(T1)、手术开始5 min(T2)、手术结束时(T3)的HR、SBP、DBP;记录术中麻醉药物的用量、手术时间、麻醉苏醒时间、人工气道拔除时间、拔除30 min 和出恢复室时的Ramsay镇静评分;记录术后第一次补救镇痛时间、补救镇痛使用次数、血管活性药物使用总次数;记录术后 2、6、12、24和48 h静息和咳嗽时的视觉模拟疼痛(VAS)评分。记录术后 48 h 恶心、呕吐发生情况。

结果 与T0时比较, T1时两组HR明显减慢, SBP、DBP均明显降低, T2时GA组SBP明显升高(P<0.05)。与GA组比较,GB组麻醉过程中舒芬太尼、丙泊酚和瑞芬太尼用量明显减少(P<0.05), 苏醒时间、人工气道拔除时间明显缩短(P<0.05), 拔管30 min时Ramsay镇静评分明显降低(P<0.05), 第一次补救镇痛时间明显延长(P<0.05), 补救镇痛使用次数和血管活性药物使用总次数明显减少(P<0.05), 术后 2 、6 和 12 h 静息和咳嗽时VAS评分均明显降低(P<0.05)。两组术后恶心呕吐差异无统计学意义。

结论 在老年股骨近端骨折手术中采用全麻联合改良髂筋膜间隙阻滞, 具有术中减少全麻药物的用量、术后恢复佳、术后镇痛效果好等优点。
英文摘要:
      
Objective To investigate the clinical efficacy of modified injection technique of ultrasound-guided fascia iliaca compartment block for upper femur fracture surgeries in the elderly.

Methods Sixty patients aged 65-99 years, 22 males and 38 females, BMI 18.6-29.7 kg/m2, ASA Ⅰ-Ⅳ level, scheduled for artificial femoral head replacement and PFNA operation were randomly divided into two groups (n=30 each): general anesthesia group (group GA) and fascia iliaca compartment block with general anesthesia group (group GB). The two groups were induced by midazolam, etomidate, sufentanil and cis atracurium, and then in group GB, modified fascia iliaca compartment block with ultrasound-guided was performed, and 0.5% ropivacaine 30 ml was given. HR, SBP and DBP were recorded at the time of entering operating room, placing the laryngeal mask, 5 min after surgery and the end of the surgery (T0-T3). The total usage of anesthetics were calculated. The operation time, recovery time, extraction of artificial airway time, Ramsay sedation score at extubation 30 min and recovery room, vasoactive drugs during operation, postoperative rescue analgesic requirements were recorded. Postoperative VAS score at 2, 6, 12, 24 and 48 h, and postoperative nausea and vomiting were also recorded.

Results Compared with T0, the HR, SBP and DBP were significantly decreased at T1 in both groups, and the SBP were significantly increased at T2 in group GA and higher than in group GB (P<0.05).The dosage of sufentanil, propofol and remifentanil in group GB were less than those in group GA, the recovery time, extubation time in group GB were shorter than those in group GA, Ramsay sedation score 30 min after extubation in group GB were lower than those in group GA (P<0.05), the time of the first rescue application analgesics in group GB were longer than those in group GA (P<0.05). Compared with group GA, the scores of the VAS in silence and coughing at 2 h, 6 h, 12 h after operation in group GB were significant lower than those in group GA (P<0.05). There were no significant differences in the incidence of nausea and vomiting between the two groups.

Conclusion Modified injection technique of ultrasound-guided fascia iliaca compartment block can ensure stable hemodynamics, reduce the dosage of anesthetic drugs, less side effects, better recovery and more indications in general anesthesia for upper femur fracture surgeries.
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