摘要
目的观察超声引导下腹股沟上髂筋膜间隙阻滞(FICB)在侧卧位直接前方入路(DAA)下全髋关节置换术(THA)患者的术后近期镇痛及临床康复效果。方法选取我院2017-01/2019-12期间择期行单侧DAA下THA患者139例,随机分为髂后路腰丛神经阻滞组(L组,n=45)、FICB组(F组,n=46)、对照组(C组,n=48)。L、F组在全麻诱导前实施超声引导下神经阻滞,L组实施后路腰丛阻滞,F组实施FICB,2组患者均予以0.375%罗哌卡因30~40 mL;C组直接予以全麻诱导。三组患者行气管插管全身麻醉,在侧卧位下行DAA下THA。记录不同时间点平均动脉压(MAP)、心率(HR),术中丙泊酚、瑞芬太尼的用量;记录患者拔管时间、麻醉恢复室(PACU)的停留时间、术后视觉模拟评分(VAS评分)。术后予以患者自控静脉镇痛(PCIA)泵术后镇痛,对患者进行随访,记录功能康复及影像学Harris评分、WOMAC评分以及关节疼痛(VAS评分)进行统计学分析。结果三组患者均有效随访1个月。三组患者在手术时间、麻醉时间上差异无统计学意义(P>0.05)。MAP在手术30 min(T3)、HR在拔管后(T4),L、F组明显低于C组(P<0.05);L组术中丙泊酚、瑞芬太尼的用量,患者拔管时间、PACU停留时间明显低于C组(P<0.05);L、F组术后24 h静息时,术后24 h、48 h、1个月运动时VAS评分明显低于C组(P<0.05);术后1个月,L、F组Harris评分明显高于C组(P<0.05),WOMAC评分明显低于C组(P<0.05)。结论FICB应用于侧卧位DAA下THA,能明显改善患者术后的急、慢性疼痛,结合良好功能康复锻炼,有利于术后早期康复;FICB应用于此类微创手术患者,镇痛效果基本等同于后路腰丛阻滞,其操作简单,成功率高,更能让患者接受。
Objecitve To investigate the efficacy of ultrasound-guided suprainguinal fascia iliaca compartment block(FICB)on postoperative short-and long-term analgesia and rehabilitative effect in patients undergoing total hip arthroplasty(THA)through the direct anterior approach(DAA)in the lateral decubitus position.Methods A total of 139 patients undergoing THA through DAA in the lateral decubitus position,from January 2017 to December 2019,were randomly divided into three groups:group L(lumbar plexus nerve block group,n=45),group F(improved suprainguinal FICB group,n=46)and group C(control group,n=48).An ultrasound-guided Shamrock lumbar plexus block was performed before surgery using a solution of 0.375%ropivicaine 30-40 mL(group L).In group F,an ultrasound-guided improved suprainguinal FICB was executed with a solution of 0.375%ropivicaine 30-40 mL.The nerve block method wasn t carried on in group C.The mean arterial pressure(MAP),heart rate(HR),total remifentanil and propofol used during operation,extubation time,time in post anesthesia care unit(PACU),the postoperative pain scores and sulfentanil consumption with patient-controlled intravenous analgesia and adverse reactions were recorded.All patients were followed.Further more,the rehabilitation of function,imaging Harris score,WOMAC score and joint pain(VAS),were also recorded.Results All patients were effectively followed up for at least one month.There was no significant difference among three groups in operation time and anesthesia time(P>0.05).Compared with group C,MAP at 30 min after operation(T 3),and HR at tube extubation(T 4)in group L and group F were decreased(P<0.05).Compared with group C,the total dosage of propofol and remifentanil,extubation time,PACU time were decreased in group L and group F(P<0.05).The VAS of rest at 24 h after surgery,the VAS of moving at 24 h,48 h and 1 month after surgery were significantly lower in group L and group F than in group C(P<0.05).Compared with group C,Harris scores of group L and group F was significantly higher(P<0.05),WOMAC score of group L and group F were significantly lower(P<0.05).Conclusion The treatment that ultrasound-guided FICB was applied to the patients undergoing THA through DAA,can obviously relieve the acute and chronic pain and bring better rehabilitation exercise.FICB is easy to be accepted by patients and anesthesiologists due to its analgesic effect being the same as the posterior lumbar plexus block,as well as being easily operated and keeping a high success rate.
作者
夏敏
柴小青
朱勃朗
章蔚
陶金
朱晨
王家武
袁季
陈旭
XIA Min;CHAI Xiaoqing;ZHU Bolang;ZHANG Wei;TAO Jin;ZHU Chen;WANG Jiawu;YUAN Ji;CHEN Xu(Department of Anesthesiology,The First Affiliated Hospital of University of Science and Technology of China(USTC),The First Affiliated Hospital of USTC,Hefei 230001,China;Department of Anesthesiology,The Fourth Affiliated Hospital of Anhui Medical university;Department of Rehabilitation,The First Affiliated Hospital of USTC,The First Affiliated Hospital of USTC,Hefei 230001,China;Department of Orthopaedics,The First Affiliated Hospital of USTC,Hefei 230001,China)
出处
《麻醉安全与质控》
2020年第4期210-215,共6页
Perioperative Safety and Quality Assurance
基金
吴阶平医学基金(320.6750.16166)。
关键词
髂筋膜间隙阻滞
全髋关节置换术
直接前方入路
术后镇痛
fascia iliaca compartment block
total hip arthroplasty
direct anterior approach
postoperative analgesia
