老年下肢手术后舒芬太尼静脉自控镇痛联合前路腰方肌阻滞的效果

目的探讨老年下肢手术后舒芬太尼静脉自控镇痛联合前路腰方肌阻滞的应用价值。方法选取老年下肢手术病人86例，采用随机数字表法分为观察组和对照组，各43例。手术结束后观察组病人患侧在超声引导下行前路腰方肌阻滞，注射0.447%甲磺酸罗哌卡因30 mL，对照组不进行腰方肌阻滞，2组病人均行舒芬太尼静脉自控镇痛。分析2组术后6 h（T₁）、12 h（T₂）、24 h（T₃）、48 h（T₄）5个时间点的静态及运动视觉模拟评分（VAS）、舒芬太尼用量及谵妄发生情况，观察2组术后T₂、T₃、T₄各时段髋关节最大屈曲度和外展度。比较2组术后次日血清炎症因子水平，包括血清肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）、白细胞介素6（IL-6）水平，并分析2组术后48 h内不良反应发生情况。结果观察组术后T₁、T₂、T₃、T₄各时段静态、运动VAS评分，舒芬太尼用量及谵妄发生率均低于对照组（P < 0.05~P < 0.01）。观察组术后T₂、T₃、T₄各时段髋关节最大屈曲度和外展度均高于对照组（P < 0.01）。观察组术后次日血清TNF-α、CRP、IL-6水平均低于对照组（P < 0.01）。观察组术后48 h内不良反应发生率低于对照组（P < 0.05）。结论老年下肢手术后使用舒芬太尼静脉自控镇痛联合前路腰方肌阻滞，术后镇痛效果确切，可减少术后舒芬太尼用量，降低术后谵妄发生率及早期血清炎性因子水平，且安全性较高。

Efficacy of the sufentanil patient-controlled intravenous analgesia combined with anterior quadratus lumborum block in elderly lower limb surgery

ObjectiveTo investigate the value of sufentanil patient-controlled intravenous analgesia combined with anterior quadratus lumborum block in lower limb surgery in the elderly.MethodsEighty-six elderly patients treated with lower limb surgery were divided into the observation group and control group by random number table method(43 cases in each group). After the operation, the affected side of the observation group received anterior quadratus lumborum block under the guidance of ultrasound, and 30 mL of 0.447% ropivacaine mesylate was injected. Two groups received patient-controlled intravenous analgesia of sufentanil. The static and motor visual analog scale(VAS), sufentanil dosage and delirium occurrence in two groups were analyzed after 6 h(T₁), 12 h(T₂), 24 h(T₃) and 48 h(T₄) of operation, and the maximum flexion and abduction of hip joint in two groups at T₂, T₃ and T₄ were observed. The levels of serum inflammatory factors(including tumor necrosis factor α(TNF-α), C reactive protein(CRP) and interleukin-6(IL-6)] were compared between two groups on the next day after surgery, and the incidence rates of adverse reactions within 48 h after surgery in two groups were analyzed.ResultsThe static and motor VAS scores, dosage of sufentanil and incidence rates of delirium in observation group were lower than those in control group at T₁, T₂, T₃ and T₄(P < 0.05 to P < 0.01). The maximum flexion and abduction of the hip joint in observation group at T₂, T₃ and T₄ were higher than those in control group(P < 0.01). The levels of TNF-α, CRP and IL-6 in observation group were lower than those in control group on the next day after operation(P < 0.01). The incidence rate of adverse reactions within 48 h after operation in observation group was lower than that in control group(P < 0.05).ConclusionsThe sufentanil patient-controlled intravenous analgesia combined with anterior quadratus lumborum block in elderly lower limb surgery has a precise postoperative analgesia effect, which can reduce the postoperative sufentanil dosage, incidence rate of postoperative delirium, level of early serum inflammatory factors, and has high safety.