摘要
目的评价髂筋膜间隙阻滞(FICB)联合单侧腰麻用于老年患者髋部骨折手术麻醉的优化效应。方法择期拟行髋部骨折手术患者57例,年龄65~85岁,BMI 18.5~30.0 kg/m2,ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为单侧腰麻组(SA组,n=28)和髂筋膜间隙阻滞联合单侧腰麻组(FICB组,n=29)。SA组患者入室后行单侧腰麻,FICB组患者入室后实施超声引导下髂筋膜间隙阻滞,然后再行单侧腰麻。2组患者均给予静脉自控镇痛至术后48 h,维持VAS评分<4分;VAS评分≥4分时,静脉注射帕瑞昔布钠40 mg补救镇痛。采用匹兹堡睡眠量表(PSQI评分)于术前1 d、术后1和3 d时评估患者睡眠功能,PSQI总分≥7分为术后睡眠障碍(POSD),记录POSD的发生情况、术后补救镇痛次数和术后并发症的发生情况。采用Harris髋关节评分量表及Barthel日常生活量表评价患者术后3 d恢复情况。于麻醉前、切皮前、术后30 min和术后24 h时测定血糖水平。于术前和术后24 h时采用ELISA法测定血浆皮质醇和褪黑素浓度。结果与SA组比较,FICB组患者POSD发生率、术后按压镇痛泵次数、补救镇痛次数、术后谵妄和恶心呕吐发生率降低,术前血糖浓度和术后24 h时血浆皮质醇浓度降低,术后24 h时血浆褪黑素浓度升高(P<0.05)。2组患者术后3 d时Harris评分和Barthel评分比较差异无统计学意义(P>0.05)。结论髂筋膜间隙阻滞联合单侧腰麻可作为有助于缓解老年髋部骨折患者围术期疼痛,改善术后睡眠,减少并发症发生的麻醉优化策略。
Objective To evaluate the optimized effect of fascia iliaca compartment block(FICB)combined with unilateral spinal anesthesia for hip fracture surgery in elderly patients.Methods Fifty-seven patients,aged 65-85 yr,with body mass index of 18.5-30.0 kg/m2,of American Society of Anesthesiologists physical statusⅡorⅢ,scheduled for elective hip fracture surgery,were divided into 2 groups using a random number table method:unilateral spinal anesthesia group(group SA,n=28)and FICB combined with unilateral spinal anesthesia group(group FICB,n=29).Patients in group SA received unilateral spinal anesthesia after entering the operating room.Patients in group FICB underwent ultrasound-guided FICB after entering the operating room,and then received unilateral spinal anesthesia.Patient-controlled intravenous analgesia was applied and maintained until 48 h after operation,and the visual analogue scale score was maintained<4 in two groups.When the visual analogue scale score was≥4,parecoxib 40 mg was intravenously injected for rescue analgesia.Pittsburgh Sleep Quality Index was used to evaluate the sleep function at 1 day before operation and 1 and 3 days after operation.Postoperative sleep disturbance(POSD)was defined as the total score of Pittsburgh Sleep Quality Index≥7.The occurrence of POSD,times of postoperative rescue analgesia and postoperative complications were recorded.The Harris Hip Score and Barthel Index were used to evaluate the functional recovery on 3rd day after operation.The blood glucose level was measured by rapid glucose meter before anesthesia,before skin incision,at 30 min after operation,and at 24 h after operation.The concentrations of plasma cortisol and melatonin were determined by enzyme-linked immunoassay before operation and at 24 h after operation.Results Compared with group SA,the incidence of POSD,pressing times of patient-controlled analgesia after operation,times of postoperative rescue analgesia and incidence of postoperative delirium and nausea and vomiting were significantly decreased,the blood glucose concentration before skin incison and plasma cortisol concentrations at 24 h after operation were decreased,and the plasma melatonin concentrations at 24 h after operation were increased in group FICB(P<0.05).There was no significant difference in the Harris scores and Barthel scores at day 3 after operation between the two groups(P>0.05).Conclusion FICB combined with unilateral spinal anesthesia can be used as an optimized anesthesia strategy helpful in relieving perioperative pain,improving postoperative sleep,and reducing the development of complications in elderly patients with hip fracture.
作者
马晶晶
武淑晶
邓立琴
侯海涛
张俊霞
王小梅
Ma Jingjing;Wu Shujing;Deng Liqin;Hou Haitao;Zhang Junxia;Wang Xiaomei(Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Cardiovascular Surgery,Shanxi Provincial People′s Hospital,Xi′an 710068,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2020年第9期1109-1112,共4页
Chinese Journal of Anesthesiology
基金
2018年自治区卫生计生系统重点研究课题(2018-NW-013)。
