超声引导下腰方肌阻滞预防性镇痛在老年患者髋部手术中的应用

摘要
图/表
参考文献(0)
相关文章 (10)

全文: PDF (789 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的： 探讨超声引导下腰方肌阻滞预防性镇痛在老年患者髋部手术中的应用价值。方法: 选择2020年9月至2022年5月在江苏大学附属医院行髋部手术患者60例，随机分为预防性镇痛组（超声引导下腰方肌阻滞预防性镇痛联合腰麻）和对照组（仅腰麻），每组30例。记录两组患者一般情况，不同时间点血流动力学指标、炎性指标、疼痛评分、术后加强镇痛用药情况及麻醉相关并发症发生率。结果: 麻醉前、腰麻摆体位时、手术开始、手术结束时两组平均动脉压和心率比较，差异均无统计学意义（P＞0.05）；预防性镇痛组神经阻滞后4 h、腰麻摆体位时VAS评分低于对照组（P＜0.05），两组术前1天16：00及术后24 h、48 h VAS评分比较，差异无统计学意义（P＞0.05）；两组患者术前1天、术后第1天、术后第3天血清CRP和IL-6水平差异均无统计学意义（P＞0.05）；两组术后首次加强镇痛用药时间、加强镇痛用药使用率、麻醉相关并发症发生率比较，差异均无统计学意义（P＞0.05）。结论: 超声引导下腰方肌阻滞预防性镇痛应用于老年患者髋部手术前，可有效缓解患者的急性疼痛状态，减少腰麻摆体位时疼痛，在围术期生命体征、炎性反应、术后镇痛效果及麻醉相关不良反应方面，预防性镇痛组相比对照组未见明显优势。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	韩玉
	蒋鹏

关键词 ：超声引导, 神经阻滞, 腰方肌阻滞, 预防性镇痛, 髋部骨折

收稿日期: 2022-10-13

基金资助:镇江市社会发展指导性科技计划项目（FZ2020032）

通讯作者: 蒋鹏（通讯作者），主任医师，硕士生导师，E-mail： doctorjp@163.com

作者简介: 韩玉（1994—），女，硕士研究生，住院医师

引用本文:

韩玉，蒋鹏. 超声引导下腰方肌阻滞预防性镇痛在老年患者髋部手术中的应用[J]. 江苏大学学报:医学版, 2023, 33(05): 444-448.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2023/V33/I05/444

［1］Tsinaslanidis G, Tsinaslanidis P, Mahajan RH. Perioperative pain management in patients undergoing total hip arthroplasty: Where do we currently stand?［J］. Cureus, 2020, 12(7): e9049.
［2］Hao J, Dong B, Zhang J, et al. Preemptive analgesia with continuous fascia iliaca compartment block reduces postoperative delirium in elderly patients with hip fracture. A randomized controlled trial［J］. Saudi Med J, 2019, 40(9): 901-906.
［3］Chen L, Shen Y, Liu S, et al. Ultrasoundguided suprainguinal fascia Iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, doubleblind clinical trial［J］. BMC Geriatr, 2021, 21(1): 669.
［4］Unneby A, Svensson PO, Gustafson PY, et al. Complications with focus on delirium during hospital stay related to femoral nerve block compared to conventional pain management among patients with hip fracture—A randomised controlled trial［J］. Injury, 2020, 51(7): 1634-1641.
［5］朱娟, 马鹏, 蒋鹏. 超声引导下髂筋膜阻滞联合腰麻在老年股骨转子间骨折闭合复位内固定术中的应用［J］. 江苏大学学报(医学版), 2022, 32(4): 345-349.
［6］Uysal A, Altparmak B, Ya??塂ar E, et al. The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial［J］. Ulus Travma Acil Cerrahi Derg, 2020, 26(1): 109-114.
［7］Doleman B, LeonardiBee J, Heinink TP, et al. Preemptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery［J］. Cochrane Database Syst Rev, 2021, 6(6): Cd012978.
［8］Blanco R. Tap block under ultrasound guidance: the description of a “no pops” technique: 271［J］. Reg Anesth Pain Med, 2007, 32(5): 130.
［9］Li J, Wei C, Huang J, et al. Efficacy of quadratus lumborum block for pain control in patients undergoing hip surgeries: A systematic review and metaanalysis［J］. Front Med (Lausanne), 2021, 8: 771859.
［10］Elsharkawy H, ElBoghdadly K, Barrington M. Quadratus lumborum block: anatomical concepts, mechanisms, and techniques［J］. Anesthesiology, 2019, 130(2): 322-335.
［11］Elsharkawy H, ElBoghdadly K, Kolli S, et al. Injectate spread following anterior subcostal and posterior approaches to the quadratus lumborum block: A comparative cadaveric study［J］. Eur J Anaesthesiol, 2017, 34(9): 587-595.
［12］Carline L, McLeod GA, Lamb C. A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks［J］. Br J Anaesth, 2016, 117(3): 387-394.
［13］Kadam VR. Ultrasoundguided quadratus lumborum block as a postoperative analgesic technique for laparotomy［J］. J Anaesthesiol Clin Pharmacol, 2013, 29(4): 550-552.
［14］Brixel SM, Biboulet P, Swisser F, et al. Posterior quadratus lumborum block in total hip arthroplasty: A randomized controlled trial［J］. Anesthesiology, 2021, 134(5): 722-733.
［15］Simons MJ, Amin NH, Cushner FD, et al. Characterization of the neural anatomy in the hip joint to optimize periarticular regional anesthesia in total hip arthroplasty［J］. J Surg Orthop Adv, 2015, 24(4): 221-224.
［16］Dam M, Moriggl B, Hansen CK, et al. The pathway of injectate spread with the transmuscular quadratus lumborum block: A cadaver study［J］. Anesth Analg, 2017, 125(1): 303-312.
［17］Li J, Lam D, King H, et al. Novel regional anesthesia for outpatient surgery［J］. Curr Pain Headache Rep, 2019, 23(10): 69.