文章摘要
术前连续髂筋膜间隙阻滞对老年髋部骨折患者围术期睡眠质量及术后谵妄的影响
Effect of preoperative continuous fascia iliaca compartment block on perioperative sleep quality and postoperative delirium in elderly patients with hip fracture
  
DOI：10.12089/jca.2020.10.004
中文关键词: 超声引导下髂筋膜间隙阻滞  髋部骨折  老年  术后谵妄  睡眠质量
英文关键词: Ultrasound-guided fascia iliaca compartment block  Hip fracture  Elderly  Postoperative delirium  Sleep quality
基金项目:西安市科技计划项目[217115SF/YX009(6)]
作者单位E-mail
徐钊 710068,西安市,陕西省人民医院麻醉科  
张玉明 710068,西安市,陕西省人民医院麻醉科  
杨瑞 710068,西安市,陕西省人民医院麻醉科  
付华君 710068,西安市,陕西省人民医院麻醉科  
蒋延安 710068,西安市,陕西省人民医院麻醉科  
常建华 710068,西安市,陕西省人民医院麻醉科 chang0808@163.com 
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中文摘要:
      
目的 探讨术前超声引导下连续髂筋膜间隙阻滞对老年髋部骨折患者围术期睡眠质量及术后谵妄的影响。
方法 选择老年髋部骨折患者121例，男55例，女66例，年龄65~90岁, BMI 18.5~25.0 kg/m2，ASA Ⅰ—Ⅲ级，采用随机数字表法分为两组：超声引导下连续髂筋膜间隙阻滞组（F组，n=61）和对照组（C组，n=60）。F组于入院后给予经超声引导下连续髂筋膜间隙阻滞，C组常规术前处理。两组采用相同的椎管内麻醉方案实施侧入路股骨头置换术，术后采用相同的术后镇痛方案。采用简易精神状态检查表（MMSE）评估入院后基础认知状态；采用匹兹堡睡眠质量指数（PSQI）评估入院前1个月整体睡眠质量。记录入院时（T1）、髂筋膜间隙阻滞后30 min（C组为入院后相同时间点）（T2）、入室时（T3）、摆放体位时（T4）的疼痛数字评分（NRS）。记录术前及术后7 d每天的里兹睡眠问卷（LSEQ）评分，记录术后7 d内谵妄的发生情况及术后住院时间。记录术后恶心、呕吐、日间嗜睡等不良反应的发生情况。
结果 与C组比较，F组T2—T4时NRS评分明显降低（P<0.05），术前及术后1~3 d LSEQ评分明显升高（P<0.05），术后7 d内谵妄发生率明显降低(P<0.05)，谵妄持续时间、术后住院时间明显缩短(P<0.05)，日间嗜睡发生率明显降低(P<0.05)。
结论 术前超声引导下连续髂筋膜间隙阻滞可改善老年髋部骨折患者围术期睡眠质量，降低术后谵妄发生率及缩短谵妄持续时间。
英文摘要:
      
Ojective To investigate the effect of preoperative ultrasound-guided continuous fascia iliaca compartment block on perioperative sleep quality and postoperative delirium in elderly patients with hip fracture.
Methods A total of 121 elderly patients with hip fracture, 55 males and 66 females, aged 65-90 years, with a BMI 18.5-25.0 kg/m2, falling into ASA physical status Ⅰ-Ⅲ, were selected and randomly divided into two groups: fascia iliaca compartment block group (group F, n = 61) and control group (group C, n = 60). The patients in group F were given ultrasound-guided continuous fascia iliaca compartment block after admission. The patients in group C were given routine preoperative treatment. The patients in the two groups were treated with the same intraspinal anesthesia scheme in femoral head replacement through lateral approach and the same PCIA scheme. All patients were assessed by MMSE and PSQI after admission. The numerical rating scale (NRS) were recorded at the time of admission (T1), 30 minutes after fascia iliaca compartment block (group C at the same time point) (T2), at the time of entry (T3), and at the time of placement (T4). The LSEQ scores of patients before and 7 days after operation were recorded. The incidence of delirium in all patients within 7 days after operation and the postoperative hospital stay were recorded. The occurrence of postoperative nausea, vomiting, daytime drowsiness and other adverse reactions was recorded.
Results Compared with group C, the NRS score in group F was significantly lower at T2-T4(P < 0.05), the LSEQ score in group F was significantly higher (P < 0.05), the incidence of delirium in group F was significantly lower (P < 0.05), the duration of delirium and the postoperative hospital stay were significantly shorter (P < 0.05), the postoperative hospital stay was significantly shorter (P < 0.05), and the incidence of daytime sleepiness in group F was significantly less (P < 0.05).
Conclusion Preoperative ultrasound-guided continuous fascia iliaca compartment block can improve the perioperative sleep quality of elderly hip fracture patients, reduce the incidence of postoperative delirium and shorten the duration of delirium.
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