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| 超声引导下腹股沟上髂筋膜阻滞对游离股前外侧皮瓣修复术后早期恢复质量的影响 |
| Effects of ultrasound-guided suprainguinal fascia iliaca block on post-operative recovery quality after free anterolateral thigh flaps repaire |
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| DOI：10.12089/jca.2024.03.009 |
| 中文关键词: 髂筋膜阻滞 超声引导 全身麻醉 股前外侧皮瓣 |
| 英文关键词: Fascia iliaca block Ultrasound-guidance General anesthesia Anterolateral thigh flap |
| 基金项目:无锡市卫生健康委重大科研项目（Z202218） |
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| 摘要点击次数: 151 |
| 全文下载次数: 86 |
| 中文摘要: |
目的：探讨术前超声引导下腹股沟上髂筋膜阻滞对四肢毁损伤患者游离股前外侧皮瓣修复术后早期疼痛及恢复质量的影响。
方法：选择因四肢毁损伤择期行游离股前外侧皮瓣修复术的患者79例，男47例，女32例，年龄18～60岁，BMI 16～28 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：超声引导下腹股沟上髂筋膜阻滞组（F组，n=39）和对照组（C组，n=40）。F组在麻醉诱导前行超声引导下腹股沟上髂筋膜阻滞，注射0.375%罗哌卡因和地塞米松5 mg混合液共30 ml；C组不行神经阻滞，所有患者全麻用药方案相同。记录术中丙泊酚、瑞芬太尼、舒芬太尼、血管活性药物用量、拔管时间、PACU停留时间；出PACU时、术后2、6、12、24、48 h静息时NRS疼痛评分；术后第1、2天镇痛泵有效按压次数及补救镇痛情况；术前、术后第1、2天15项恢复质量量表（QoR-15）评分；术后48 h内不良反应（头晕、恶心呕吐、皮肤瘙痒、呼吸抑制、低氧血症等）发生情况；出院时皮瓣供区伤口愈合、受区存活情况及住院时间。
结果：与C组比较，F组术中瑞芬太尼、舒芬太尼用量及使用血管活性药的例数明显降低，拔管时间、PACU停留时间明显缩短（P<0.05）；术后2、6 h静息时NRS疼痛评分和术后第1天镇痛泵有效按压次数、补救镇痛率均明显降低（P<0.05）；术后第1、2天的QoR-15评分均明显提高（P<0.05）；术后48 h内头晕、恶心呕吐的发生率明显降低（P<0.05）。两组术中丙泊酚用量，出PACU时、术后12、24、48 h静息时NRS疼痛评分，术后第2天镇痛泵有效按压次数及补救镇痛率，术后皮肤瘙痒、呼吸抑制、低氧血症发生率，皮瓣供区愈合率、受区存活率及住院时间差异均无统计学意义。
结论：超声引导腹股沟上髂筋膜阻滞应用于游离股前外侧皮瓣修复四肢毁损伤可减少围术期镇痛药用量，缩短麻醉复苏时间，缓解术后早期疼痛，减少术后不良反应发生，提高术后早期恢复质量。 |
| 英文摘要: |
Objective: To investigate the effects of ultrasound-guided suprainguinal fascia iliaca block (SFIB) on peri-operative analgesia and postoperative recovery quality in repairing the wounds of limbs with free anterolateral thigh (ALT) flaps.
Methods: Seventy-nine patients with limb wounds repaired with free ALT flaps, aged 18-60 years, BMI 16-28 kg/m2, ASA physical status Ⅰ-Ⅲ were included. Patients were assigned into two groups according to random number table method: ultrasound-guided SFIB group (group F, n = 39) and control group (group C, n = 40). Ultrasound-guided SFIB was performed before anesthesia induction, and 30 ml of 0.375% ropivacaine and dexamethasone 5 mg were injected in group F. There was no nerve blocked in group C. All patients received the same general anesthesia regimen. The intraoperative dosage of propofol, remifentanil, sufentanil, vasoactive drugs, anesthetic recovery time were recorded, NRS scores at rest immediately before leaving PACU and 2, 6, 12, 24, and 48 hours after surgery, the valid number of pressing patient-controlled intravenous analgesia (PCIA) pump, the rate of rescue analgesia on postoperative day 1 and day 2, the 15-item quality of recovery (QoR-15) scores before operation, on postoperative day 1 and day 2, the incidence of postoperative adverse reactions (dizziness, nausea and vomiting, pruritus, respiratory depression, hypoxemia), the wound healing rates of donor sites, flap survival rates of reception sites and hospitalization time were recorded.
Results: Compared with group C, patients in group F required less remifentanil, sufentanil and vasoactive drugs for anesthesia maintenance, (P < 0.05), the recovery time, the length of stay in PACU in group F were significantly decreased (P < 0.05), NRS scores at rest 2 and 6 hours after surgery were significantly decreased in group F (P < 0.05). The valid number of pressing PCIA pump, the need for rescue analgesia on postoperative day 1, the QoR-15 scores on postoperative day 1 and day 2 and the incidence of adverse reactions, including dizziness and nausea and vomiting within 48 hours after surgery in group F were significantly reduced (P < 0.05). There were no significant differences in dosage of propofol, NRS scores at rest immediately before leaving PACU, 12, 24, and 48 hours after surgery, as well as the valid number of pressing PCIA pump and the need for rescue analgesia on the second day after operation, the incidence of pruritus, respiratory depression and hypoxemia within 48 hours after surgery, the wound healing rates of donor sites, flap survival rates of reception sites and hospitalization time between two groups.
Conclusion: Ultrasound-guided SFIB before surgery can relieve the postoperative pain significantly, reduce the peri-operative analgesic requirements, the incidence of opioid relevant complications and accelerate the early recovery for patients with limb wounds repaired with free ALT flaps. |
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