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| 不同浓度及容量罗哌卡因髋关节囊周围神经阻滞用于髋部骨折老年患者镇痛效果的比较 |
| Comparison of analgesic effect of pericapsular nerve group block of hip joint with different concentrations and volumes of ropivacaine in elderly patients with hip fracture |
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| DOI：10.12089/jca.2022.05.010 |
| 中文关键词: 髋关节囊周围神经阻滞 髋部骨折 体位变动 蛛网膜下腔阻滞 |
| 英文关键词: Pericapsular nerve group block of hip joint Fracture of hip Change of posture Spinal anesthesia |
| 基金项目:2020年度创新基地的人才计划甘肃省中西医结合麻醉临床医学研究中心（20JR10RA435） |
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| 中文摘要: |
目的 比较不同浓度及容量罗哌卡因髋关节囊周围神经（PENG）阻滞用于髋部骨折老年患者体位变动时的镇痛效果。
方法 选择腰麻下行髋部骨折手术患者180例，男82例，女98例，年龄65～85岁，BMI 18～28 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为六组：0.45%罗哌卡因20 ml组（A1组）、0.45%罗哌卡因10 ml组（B1组）、0.45%罗哌卡因5 ml组（C1组）、0.25%罗哌卡因20 ml组（A2组）、0.25%罗哌卡因10 ml组（B2组）和0.25%罗哌卡因5 ml组（C2组），每组30例。所有患者均在腰麻前按照上述剂量行超声引导下术侧PENG阻滞。记录神经阻滞前、神经阻滞后5、10 min时静息和活动时NRS评分，记录腰麻摆体位时活动时NRS评分。记录术后当天及第1天股四头肌肌力分级和局麻药中毒、神经损伤、血肿形成等不良反应的发生情况。
结果 神经阻滞前六组静息和活动时NRS评分差异无统计学意义。与神经阻滞前比较，神经阻滞后5 min、10 min时A1组、B1组、C1组、A2组和B2组静息和活动时NRS评分均明显降低（P＜0.05），神经阻滞后10 min C2组静息和活动时NRS评分明显降低（P<0.05）。与神经阻滞后5 min比较，神经阻滞后10 min C2组静息时NRS评分明显降低（P<0.05）。与神经阻滞后10 min比较，腰麻摆体位时C1组、C2组活动时NRS评分明显升高（P<0.05）。与C1组比较，神经阻滞后5 min、10 min、腰麻摆体位时A1组、B1组活动时NRS评分明显降低（P<0.05），神经阻滞后10 min，腰麻摆体位时C2组活动时NRS评分明显升高（P<0.05）。与C2组比较，神经阻滞后5 min、10 min、腰麻摆体时A2组、B2静息和活动时NRS评分均明显降低（P<0.05）。术后当天B2组股四头肌肌力完5级例数明显多于A1组、A2组和B1组（P<0.05）。六组均无局麻药中毒、神经损伤、血肿形成等不良反应发生。
结论 超声引导下PENG阻滞对髋部骨折患者麻醉前体位变动有良好的镇痛效果，0.25%罗哌卡因10 ml可提供良好镇痛的效果，对股四头肌肌力影响更小，且不增加不良反应。 |
| 英文摘要: |
Objective To compare the analgesic effect of pericapsular nerve group block of hip joint with different concentration and volume of ropivacaine on postural changes in elderly patients with hip fracture.
Methods A total of 180 patients with hip fracture scheduled for operation under spinal anesthesia, 82 males and 98 females, aged 65-85 years, BMI 18-28 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into 6 groups: 0.45% ropivacaine 20 ml group (group A1), 0.45% ropivacaine 10 ml group( group B1) and 0.45% ropivacaine 5 ml group (group C1), 0.25% ropivacaine 20 ml group( group A2), 0.25% ropivacaine 10 ml group (group B2) and 0.25% ropivacaine 5 ml group (group C2), 30 patients in each group. Ultrasound-guided pericapsular nerve group block of hip joint was performed in all patients before lumbar anesthesia. Static NRS scores were recorded before nerve block, 5 minutes and 10 minutes after nerve block. Dynamic NRS scores were recorded before nerve block, 5 minutes and 10 minutes after nerve block and lumbar anesthesia position. The muscle strength grade of quadriceps femoris on the day and the first day after operation, and the occurrence of adverse reactions were recorded.
Results There was no significant differences in static and dynamic NRS scores among the 6 groups before nerve block. Compared with before nerve block, the static and dynamic NRS scores of groups A1, B1, C1, A2, and B2 were decreased continuously at 5 minutes and 10 minutes after nerve block, the static and dynamic NRS scores of group C2 were decreased significantly at 10 minutes after nerve block (P < 0.05). Compared with 5 minutes after nerve block, the static NRS score of group C2 was decreased significantly at 10 minutes after nerve block (P < 0.05). Compared with 10 minutes after nerve block, the NRS score of lumbar anesthesia position in groups C1 and C2 was significantly higher (P < 0.05). Compared with group C1, the dynamic NRS score of groups A1 and B1 were significantly lower at 5 minutes and 10 minutes after nerve block and lumbar anesthesia position (P < 0.05). Compared with group C2, the static and dynamic NRS scores in groups A2 and B2 were significantly lower at 5 minutes and 10 minutes after nerve block and lumbar anesthesia position (P < 0.05). The number of complete quadriceps muscle strength in group B2 was significantly higher than that in groups A1, A2, and B1 on the day after operation (P < 0.05). There were no adverse reactions of ropivacaine in the six groups, including local anesthetic poisoning, nerve injury, hematoma formation.
Conclusion Ultrasound-guided pericapsular nerve group block has a good analgesic effect on postural changes in patients with hip fracture before anesthesia. 0.25% ropivacaine 10 ml can provide a good analgesic effect, but has less effect on quadriceps muscle strength and does not increase the occurrence of adverse reactions. |
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