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| 髂筋膜间隙阻滞对老年患者髋部骨折手术围术期镇痛的影响Meta分析 |
| Effects of single fascia iliac compartment block on perioperative analgesia in elderly hip fracture patients：a meta-analysis |
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| DOI：10.12089/jca.2021.07.015 |
| 中文关键词: 髂筋膜间隙阻滞 髋部骨折 镇痛 Meta分析 随机对照试验 |
| 英文关键词: Iliac fascia block Hip fracture Analgesia Meta-analysis Randomized controlled trial |
| 基金项目:天津市企业博士后创新项目择优资助计划（TJQYBSH2018020）；天津市卫健委科技人才培育项目（RC20112） |
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| 中文摘要: |
目的 采用Meta分析的方法系统评价髂筋膜间隙阻滞（FICB）对老年患者髋部骨折手术围术期镇痛效果及安全性的影响。
方法 检索Medline、Ovid、Cochrane、Embase、知网、万方、维普等数据库，收集1996—2020年发表的FICB用于老年患者髋部骨折手术的随机对照试验(RCT)，对照组在围术期给予生理盐水。按Cochrane指导手册的方法选择文献、提取资料及评价研究质量。采用RevMan 5.3软件进行Meta分析。
结果 共纳入9篇发表于2007—2019年的RCT研究，共计675例患者，其中研究组353例，对照组322例。与对照组比较，研究组术后24 h内患肢活动时VAS疼痛评分明显降低（SMD=-1.82，95%CI -2.26~-1.38），术后24 h内阿片类药物累计用量明显减少（SMD=-0.69，95%CI -0.95~-0.42）。两组术后24 h内患肢静息时VAS疼痛评分（SMD=-0.56，95%CI -1.44~0.31）、爆发痛发生率（RR=0.66，95%CI 0.36~1.23）、总住院时间（SMD=0.36，95%CI -1.50~2.23）以及术后恶心呕吐发生率（RR=2.31，95%CI 0.24~22.53 ）差异无统计学意义。
结论 围术期使用髂筋膜间隙单次阻滞能够缓解老年患者髋部骨折术后早期运动疼痛程度及总体麻醉药用量，但不会缩短住院时间。 |
| 英文摘要: |
Objective To evaluate the efficacy and safety of single fascia iliac compartment block (FICB) on perioperative period of elderly hip fracture patients by meta-analysis.
Methods PubMed, Cochrane, Embase, Ovid, CNKI, WanFang and VIP databases were searched for randomized placebo-controlled trials published from 1996 to 2020, involving the efficacy of single block of iliac fascia space in perioperative period of elderly hip fracture patients. The methodological quality of the included randomized controlled trials (RCTs) was assessed and the data were extracted according to the Cochrane Handbook. The Meta-analysis was performed by using RevMan 5.3 software.
Results Nine RCTs published from 2007 to 2019, involving 675 patients were retrieved, including 353 in the study group and 322 in the control group. Compared with the control group, the VAS score of study group at movement was significantly reduced within 24 hours after surgery (SMD = -1.82, 95% CI -2.26 to -1.38). The VAS score at rest were similar within 24 hours after surgery between two groups (SMD = -0.56, 95% CI -1.44 to 0.31). The incidence of outbreak pain was similar between two groups (RR = 0.66, 95 % CI 0.36 to 1.23). Compared with the control group, the cumulative dose of opioid anesthetics in the study group during the perioperative period was significantly reduced 24 hours after surgery (SMD = -0.69, 95% CI -0.95 to -0.42). The length of stay (SMD = 0.36, 95% CI -1.50 to 2.23) and the probability of nausea and vomiting (RR = 2.31, 95% CI 0.24 to 22.53) in the study group were similar to those in the control group.
Conclusion The use of a single block of the iliac fascial space during the perioperative period can relieve the pain of elderly patients with hip fractures and reduce the total cumulative amount of anesthetics, especially for patients who need moderate movement of the affected limb, but the length of stay in the hospital is similar. |
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