| 宋峰,钮峥嵘,杜晓宣.不同方式超声引导连续髂筋膜阻滞在髋关节置换术后镇痛效果.骨科,2018,9(2): 136-140. |
| 不同方式超声引导连续髂筋膜阻滞在髋关节置换术后镇痛效果 |
| Analgesia effects of two different methods of ultrasound-guided continuous fascia iliaca compartment block for total hip arthroplasty |
| 投稿时间：2017-11-19 |
| DOI：10.3969/j.issn.1674-8573.2018.02.011 |
| 中文关键词: 超声检查 关节成形术，置换，髋 神经传导阻滞 镇痛 |
| 英文关键词: Ultrasonography Arthroplasty, replacement, hip Nerve block Analgesia Rehabilitation |
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| 中文摘要: |
| 目的 对两种不同方式超声引导连续髂筋膜间隙阻滞在髋关节置换术后镇痛效果进行评价。方法 采用前瞻性随机对照研究，纳入新疆医科大学第六附属医院于2016年3月至2017年10月收治的腰-硬联合阻滞麻醉下人工全髋关节置换术（total hip arthroplasty, THA）术后病人60例，男29例，女31例，年龄为65~83岁，平均（66.78±9.32）岁。按照数字随机法分为：①腹股沟韧带上髂筋膜阻滞组（上髂筋膜组）30例，男17例，女13例，年龄为65~84岁，平均（66.13±9.16）岁；②腹股沟韧带下髂筋膜阻滞组（下髂筋膜组）30例，男12例，女18例，年龄为65~82岁，平均（65.80±8.13）岁。在超声引导下行髂筋膜连续神经阻滞后镇痛，设置两组镇痛泵的局部麻醉药物均为0.2%的罗哌卡因200 ml，负荷量20 ml，置管成功后注入，背景量为0。病人自控镇痛（patient controlled analgesia, PCA）10 ml/次，锁定时间为1 h。对病人的静息疼痛、持续性被动疼痛和主观性疼痛等疼痛视觉模拟量表（visual analogue scale, VAS）评分进行记录，对病人的阻滞效果、曲马多用量以及病人满意度进行评价。结果 上髂筋膜组的手术时间为（70.4±12.1） min，下髂筋膜组为（70.8±10.3） min，两组比较差异无统计学意义（P＞0.05）。在静息状态、主被动VAS评分方面，上髂筋膜组均优于下髂筋膜组；上髂筋膜组病人阻滞后各时间点股外侧皮神经支配区的感觉阻滞程度和曲马多使用量优于下髂筋膜组，以上指标比较，两组差异均有统计学意义（均P＜0.05）。两组病人阻滞后各时间点股神经阻滞率和术后镇痛满意度比较，差异均无统计学意义（均P＞0.05）。结论 THA术后采用超声引导下浓度为0.2%罗哌卡因，在THA术后镇痛效果上，腹股沟韧带上连续髂筋膜阻滞明显优于腹股沟韧带下连续髂筋膜神经阻滞。 |
| 英文摘要: |
| Objective To evaluate the analgesia effects of two different methods of ultrasound-guided continuous fascia iliaca compartment block (FICB) for total hip arthroplasty (THA). Methods This is a prospective randomized controlled study on the patients who were treated with THA under combined spinal epidural analgesia in the Sixth Affiliated Hospital of Xinjiang Medical University between March 2016 and October 2017. Sixty patients (29 males and 31 females with age ranging from 65-83 years, mean 66.78±9.32) scheduled for hip replacement under combined spinal and epidural anesthesia were included in this study. These patients were randomly assigned to receive ultrasound-guide continuous FICB either above (superior iliac fascia group, 17 males and 13 females with age ranging from 65-84 years, mean: 66.13±9.16) or below (inferior iliac fascia group, 12 males and 18 females with age ranging from 65-82 years, mean: 65.80±8.13) the inguinal ligament postoperatively in the post anesthesia care unit. The patient controlled analgesia (PCA) was set up with loading 20 ml dosage of 0.2%, 200 ml ropivacaine and only bolus mode with no continuous infusion. PCA was set up as 10 ml each time in every one h. The visual analog scale (VAS) and the tramadol for remedial analgesia consumption were recorded and analyzed. Results Total operation time was 70.4±12.1 min in superior iliac fascia group and 70.8±10.3 min in inferior iliac fascia group (P＞0.05). The patients in the superior iliac fascia group reported less pain than those in the inferior iliac fascia group over time at different time points. The tramadol consumption was less in the superior iliac fascia group than in the inferior iliac fascia group but with higher satisfaction rating scale. Conclusion Pain relief was superior in the continuous FICB above the inguinal ligament than below the inguinal ligament with less tramadol consumption and higher satisfaction rating scale. |
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