连续腰丛阻滞用于老年全髋关节 置换术后镇痛的临床效果

Clinical efficacy of continuous lumbar plexus block on analgesia for elderly patients with total hip arthroplasty

摘要:

目的 探讨连续腰丛阻滞用于老年全髋关节置换术后镇痛的临床效果。方法 选取2017 年1 月— 2017 年11 月雅安市中医医院收治的48 例全髋关节置换术后的老年患者，按照随机数字表法分为对照组和研 究组，每组24 例。对照组采用静脉自控镇痛（PCIA）方法，研究组采用连续腰丛阻滞镇痛。比较两组治疗效果、 不良反应发生率、美国膝关节协会评分（AKS）、视觉模拟评分（VAS）及髋关节活动度。结果 研究组治疗 后髋关节功能Harris 评分优良率高于对照组（P <0.05），而不良反应率低于对照组（P <0.05）。两组术前及术后3、 6 和12 个月的AKS 和VAS 评分在不同时间、不同组间及变化趋势上有差异（P <0.05）；研究组术后3、6 和 12 个月的AKS 评分较对照组高，而VAS 评分较对照组低。研究组髋关节屈曲、外展、内收、外旋及内旋等 活动度高于对照组（P <0.05）。结论 连续腰从阻滞用于老年全髋关节置换术后镇痛效果良好，临床价值较高， 值得临床推广。

Abstract:

Objective To evaluate the clinical efficacy of continuous lumbar plexus block on analgesia for elderly patients with total hip arthroplasty (THA). Methods A total of 48 elderly patients undergoing the THA from January 2017 to December 2017 in our hospital were selected, and were randomly assigned to the control group and the study group. The control group was treated with the patient-controlled intravenous analgesia (PCIA), and the study group received the continuous lumbar plexus block. The therapeutic effect, incidence of adverse event, AKS (American Knee Society) scores, VAS (visual analogue scale) scores and range of motion of the hip joint were compared. Results Based on the Harris hip score, the good rate of hip joint function in the study group was higher than that in the control group (P < 0.05), and the incidence of adverse event in the study group was lower than that in the control group (P < 0.05). With repeated measures analysis of variance, we found that the AKS score and VAS score between the study group and the control group were different at 3, 6 and 12 months after operation (P < 0.05). Compared with the control group, the study group had higher AKS scores and lower VAS scores at these time points. There was a difference in the changing trend of AKS score between the study group and the control group (P < 0.05). The range of motion like joint flexion, abduction, adduction, extorsion and intorsion in the study group was better than that in the control group (P < 0.05). Conclusions The continuous lumbar plexus block has a better analgesia effect for elderly patients with THA, and should be further applied in clinical practice.