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| 超声引导下髋关节囊周神经丛阻滞对股骨颈骨折老年患者摆放侧卧位时疼痛的影响 |
| Ultrasound-guided hip pericapsular nerve group block for pain control in patients with femoral neck fracture during posture changing |
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| DOI：10.12089/jca.2020.08.006 |
| 中文关键词: 股骨颈骨折 髂筋膜间隙阻滞 关节囊周神经丛阻滞 超声引导 |
| 英文关键词: Femoral neck fracture Fascia iliaca compartment block Pericapsular nerve group block Ultrasound-guided |
| 基金项目:佛山市卫生局研究计划课题（2014178）；佛山市科技创新项目（医学科技创新平台建设项目，FS0AA-KJ218-1301-0041） |
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| 中文摘要: |
目的 比较超声引导下髋关节囊周神经丛阻滞（PENGB）和腹股沟上髂筋膜间隙阻滞（S-FICB）对股骨颈骨折患者麻醉前摆放侧卧位时疼痛的影响。
方法 择期腰-硬联合麻醉下行髋关节置换术的股骨颈骨折患者42例，男18例，女24例，年龄≥65岁，BMI 18~28 kg/m2，ASA Ⅱ或Ⅲ级，所有患者在腰-硬联合麻醉体位变动之前，在超声引导下进行单次神经阻滞，根据神经阻滞入路不同，随机分为两组，每组21例。P组行PENGB，S组行S-FICB，两组均给予0.25%罗哌卡因30 ml。记录阻滞前（T1）和阻滞后5 min（T2）、10 min（T3）、15 min（T4）及摆放侧卧位即刻（T5）和侧卧位后即刻（T6）的VAS疼痛评分、MAP和HR，记录超声成像时间、穿刺注药时间、超声成像清晰度评分、患者满意度和配合度评分及相关并发症。
结果 与T1时比较，T2—T6时两组VAS疼痛评分明显降低（P<0.05）。与S组比较，T2—T6时P组VAS疼痛评分明显降低（P<0.05）。与T1时比较，T2—T4和T6时两组MAP明显降低（P<0.05）。与T1时比较，T3、T4时P组HR明显减慢（P<0.05）。与S组比较，P组超声成像时间明显缩短（P<0.05），镇痛满意度评分明显提高（P<0.05）。两组穿刺注药时间、超声成像清晰度评分和配合度评分差异无统计学意义。两组均无一例穿刺相关并发症。
结论 超声引导下PENGB和S-FICB对股骨颈骨折患者术前摆放侧卧位时都有良好的镇痛效果，PENGB超声成像时间更短，起效更快，患者满意度更高。 |
| 英文摘要: |
Objective To compare the analgesic efficiency of ultrasound-guided hip pericapsular nerve group block (PENGB) versus supra-inguinal fascia iliaca compartment block(S-FICB) in patients with femoral neck fracture in lateral position before combined spinal-epidural anesthesia.
Methods Forty-two patients with femoral neck fracture scheduled for elective hip arthroplasty were selected, 18 males and 24 females, ASA physical status Ⅱ or Ⅲ. All patients were undergoing single nerve block for analgesia guided under ultrasound before changes of position for combined spinal-epidural anesthesia. According to the different approaches for nerve block, the patients were randomly divided into two groups: group P was given PENGB, while group S was given S-FICB (n = 21 in each), 30 ml of 0.25% ropivacaine hydrochloride was used. The visual analogue scale (VAS) scores, MAP and HR were recorded before block (T1) and at 5 min (T2), 10 min (T3) and 15 min (T4) after block, at the time of the position changing (T5) and the time immediately after position change (T6) in the two groups. Imaging time, needling time and ultrasound visibility score, patient’s satisfaction and cooperation, adverse reactions and complications were also recorded.
Results VAS scores at T2-T6 in both groups were significantly lower than that at T1(P < 0.05). VAS scores at T2-T6 in group P were significantly lower than that in group S (P < 0.05). In both groups, MAP at T2-T4 and T6 were lower than that at T1 (P < 0.05), while HR at T3-T4 were lower than that at T1 in group P (P < 0.05). Imaging time in group P was shorter than that in group S (P < 0.05). The satisfaction of group P was higher than that of group S (P < 0.05). There was no statistically significant difference between the two groups in MAP, HR, needling time, ultrasound visibility score, and patient’s cooperation. No patient had adverse reactions and complications of nerve block.
Conclusion Both PENGB and S-FICB have good analgesic effect on the preoperative position change in patients with femoral neck fracture. However, PENGB has shorter imaging time, a more rapid onset of action and higher patients satisfaction. |
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