超声引导下连续髂筋膜间隙阻滞用于老年髋部骨折患者围术期镇痛的研究

目的:研究超声引导下髂筋膜间隙阻滞对老年髋部骨折患者围手术期疼痛控制及术后并发症的影响。方法:选择2021年1月至2021年9月收治的老年髋部骨折手术患者127例,按照镇痛方法不同分为连续髂筋膜间隙阻滞组(F组)和静脉镇痛对照组(C组)。其中F组62例,男19例,女43例;年龄66~95(82.4±7.2)岁;股骨颈骨折25例,股骨转子间骨折37例。C组65例,男18例,女47例;年龄65~94(81.4±8.7)岁;股骨颈骨折29例,股骨转子间骨折36例。观察两组患者围术期不同时间点的疼痛视觉模拟评分(visual analogue scale,VAS)、简易精神状态评价量表(minimental state examination,MMSE)评分、警觉-镇静评分(observer''s assessment of alertness/sedation,OAA/S)、改良Bromage评分、术后并发症及患者住院期间情况。结果:F组实施阻滞后30 min、麻醉摆放体位时,术后6、24、48 h的静息及运动VAS低于C组(P<0.05)。F组术前12 h,术后1、3 d的MMSE评分及术后3 d的OAA/S评分高于C组(P<0.05)。F组不良反应发生率、需要额外镇痛人数低于C组(P<0.05)。F组围术期镇痛满意度及住院时间均优于C组(P<0.05)。两组患者在各时间点患肢Bromage评分及术后30 d死亡率比较,差异无统计学意义(P>0.05)。结论:超声引导下连续髂筋膜间隙阻滞可为老年髋部骨折患者提供安全、有效的围术期镇痛效果,改善术后认知功能,减少术后并发症,从而缩短住院时间,提高住院期间生活质量。

Ultrasound-guided continuous fascia iliaca compartment block for perioperative pain management in elderly patients undergoing hip fracture surgery

Objective To study the effect of ultrasound-guided fascia iliaca compartment block on perioperative analgesia and postoperative complications in geriatric patients with hip fractures. Methods A total of 127 elderly patients undergoing hip fracture surgery from January 2021 to September 2021 were randomized to receive ultrasound-guided continuous fascia iliaca compartment block(group F) either intravenous analgesia control group(group C). There were 62 cases in group F,including 19 males and 43 females with an average age of (82.4±7.2) years old ranging from 66 to 95 years old,involving 25 femoral neck fractures and 37 femoral intertrochanteric fractures. There were 65 cases in control group,including 18 males and 47 females,with an average age of (81.4±8.7) years old ranging from 65 to 94 years old,involving 29 femoral neck fractures and 36 femoral intertrochanteric fractures. The visual analogue scale(VAS),minimental state examination (MMSE),observer''s assessment of alertness/sedation(OAA/S) scale,modified Bromage score,postoperative complications and general conditions during hospitalization in two groups were observed. Results The resting and exercise VAS at 30 min after block,anesthesia placement and 6,24 and 48 h after surgery were lower than those in group C(P<0.05). In group F,MMSE scores at 12 h before surgery,and 1,3 d after surgery and OAA/S scores at 3 d after surgery were higher than those in group C(P<0.05). The incidence of adverse effects and the number requiring additional analgesia were lower than those in group C(P<0.05). Group F had better perioperative analgesia satisfaction and hospital stay than group C(P<0.05). But there was no significant difference regarding Bromage score and 30-day mortality between two group(P>0.05). Conclusion Ultrasound-guided continuous fascia iliacus space block was safe and effective for elderly patients with hip fracture,and could significantly reduce perioperative pain,improve postoperative cognitive function,and reduce postoperative complications,thereby shortening hospital stay and improving the quality of life during hospitalization.