文章摘要
超声引导下髂腰肌平面阻滞对髋关节置换术患者术后恢复质量的影响
Effect of ultrasound-guided iliopsoas plane block on quality of postoperative recovery in patients undergoing hip arthroplasty
  
DOI：10.12089/jca.2024.02.005
中文关键词: 髂腰肌平面阻滞  股神经阻滞  髋关节置换术  全身麻醉  恢复质量
英文关键词: Iliopsoasplane block  Femoral nerve block  Artificial hip arthroplasty  General anesthesia  Quality of recovery
基金项目:保定市科技计划项目（2241ZF238）；河北医科大学在读研究生创新能力培养资助项目（XCXZZS202313）
作者单位E-mail
姜卜维 071000,河北省保定市第一中心医院麻醉科  
马凤丹 071000,河北省保定市第一中心医院麻醉科  
黄瑾 071000,河北省保定市第一中心医院麻醉科  
张珈硕 071000,河北省保定市第一中心医院麻醉科  
韩亚楠 071000,河北省保定市第一中心医院麻醉科  
王晟昱 071000,河北省保定市第一中心医院麻醉科  
宋立杰 071000,河北省保定市第一中心医院泌尿外科  
柳进宁 071000,河北省保定市第一中心医院麻醉科  
赵克非 071000,河北省保定市第一中心医院麻醉科  
王春光 071000,河北省保定市第一中心医院麻醉科 13831253611@163.com 
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中文摘要:
      
目的：观察超声引导下髂腰肌平面阻滞对髋关节置换术患者术后恢复质量的影响。
方法：选择择期行人工髋关节置换术的患者60例，男37例，女23例，年龄40～79岁，BMI 18～30 kg/m2，ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组：髂腰肌平面阻滞组（IPB组）和股神经阻滞组（FNB组），每组30例。麻醉诱导前，IPB组采用0.5%罗哌卡因10 ml行超声引导下IPB，后采用0.5%罗哌卡因5 ml行股外侧皮神经阻滞；FNB组采用0.5%罗哌卡因10 ml行超声引导下FNB，后采用0.5%罗哌卡因5 ml行股外侧皮神经阻滞。记录术中丙泊酚、瑞芬太尼和顺式阿曲库铵用量。采用15项恢复质量（QoR-15）量表评估术前、术后1、2、3 d的恢复质量。记录术后12、24、48 h最高VAS（VASmax）疼痛评分和股四头肌徒手肌力测试（MMT）评分。记录术后首次下床活动时间、阿片类药物用量、患者满意度评分。记录神经损伤、血管损伤、穿刺部位感染和局麻药中毒等神经阻滞相关并发症的发生情况。记录头晕、恶心呕吐、深静脉血栓和谵妄等术后并发症的发生情况。
结果：两组术中丙泊酚、瑞芬太尼和顺式阿曲库铵用量差异无统计学意义。与FNB组比较，IPB组术后1、2、3 d QoR-15量表评分明显升高（P<0.05）。与FNB组比较，IPB组术后12、24 h股四头肌MMT评分明显升高，术后首次下床活动时间明显缩短（P<0.05）。两组术后VASmax疼痛评分、术后48 h股四头肌MMT评分、阿片类药物用量和患者满意度评分差异无统计学意义。两组均未见神经阻滞等相关并发症。两组术后并发症发生率差异无统计学意义。
结论： 超声引导下髂腰肌平面阻滞可提高髋关节置换术患者术后恢复质量，加速患者康复，效果优于股神经阻滞。
英文摘要:
      
Objective: To observe the effect of ultrasound-guided iliopsoas plane block (IPB) on the quality of postoperative recovery in patients undergoing hip arthroplasty.
Methods: Sixty patients who underwent hip arthroplasty were selected, 37 males and 23 females, aged 40-79 years, BMI 18-30 kg/m2, ASA physical status Ⅰ-Ⅲ. The patients were divided into two groups by random number table method: the iliopsoas plane block group (group IPB) and the femoral nerve block (FNB) group (group FNB), 30 patients in each group. Before anesthesia induction, IPB was performed with 0.5% ropivacaine 10 ml and lateral femoral cutaneous nerve block was performed with 0.5% ropivacaine 5 ml in group IPB. And FNB was performed with 0.5% ropivacaine 10 ml and lateral femoral cutaneous nerve block was performed with 0.5% ropivacaine 5 ml in group FNB. The dosages of propofol, remifentanil, and cis-atracurium during operation were recorded. The quality of recovery-15 (QoR-15) scale was evaluated preoperatively and postoperatively 1 day, 2 and 3 days. The max VAS (VASmax) pain score and manual muscle test (MMT) score of quadriceps muscle were recorded 12, 24, and 48 hours after surgery. The time of getting out of bed for the first time, opioid dosage, and patient satisfaction were recorded. The incidence of nerve injury, vascular injury, puncture site infection, and local anesthetic poisoning were recorded. The postoperative complications of dizziness, nausea and vomiting, deep vein thromboses, and elirium were also recorded.
Results: There was no significant difference in the dosage of propofol, remifentanil, and cis-atracurium between the two groups. Compared with group FNB, the QoR-15 scale score in group IPB was significantly higher 1 day, 2 and 3 days after operation (P < 0.05). Compared with group FNB, the MMT scores of quadriceps muscle was significantly higher in group IPB 12 and 24 hours after surgery (P < 0.05), and the first time of getting out of bed was shortened in group IPB (P < 0.05). However, there were no significant differences in the VASmax pain score, MMT score of quadriceps muscle 48 hours after surgery, opioid dosage, and patient satisfaction between the two groups. No nerve block related complications were found in both groups. There were no significant differences in postoperative complications between the two groups.
Conclusion: The iliopsoas plane block can improve the quality of postoperative recovery and accelerate the recovery of patients with hip replacement, and the effect is better than that of femoral nerve block.
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