超声引导下髂筋膜间隙阻滞在老年髋部骨折患者早期镇痛中的应用

The effects of ultrasound-guided fascia iliaca compartment block on early analgesia in elderly patients with hip fracture

摘要:

目的 评价超声引导下髂筋膜间隙阻滞 （FICB） 在老年髋部骨折患者早期镇痛中的应用。 方法 选取2018年1月—2018年12月中国医科大学附属盛京医院收治的80例老年髋部骨折患者作为研究对 象，采用随机数字表法将其分为超声引导下行FICB（实验组）和静脉注射氟比洛芬酯镇痛（对照组），每组40 例。实验组在超声引导下行FICB，给予0.3%的罗哌卡因0.5 ml/kg；对照组静脉注射氟比洛芬酯50 mg。比较 两组实施镇痛前即刻（Ｔ0 ）、镇痛后30 min（T1 ）和1 h（T2 ）、6 h（T3 ）及12 h（T4 ）的视觉模拟评分法（VAS）、平均动 脉压（MAP）、心率（HR）；比较两组恶心呕吐、嗜睡、尿潴留、低血压；比较两组穿刺部位出血、血肿及局部麻醉 药中毒等的发生率；比较两组口服泰勒宁镇痛例数及用药剂量。结果 T1、T2、T3、T4时间点的静息痛评分、被 动运动痛评分在不同时间、不同组间有差异（P <0.05），变化趋势无差异（P >0.05）。T1、T2、T3、T4时间点静息状 态下MAP在不同时间、不同组间及变化趋势上无差异（P >0.05）。T1、T2、T3、T4时间点被动运动时MAP和HR 在不同时间、不同组间及变化趋势上有差异（P <0.05）。T1、T2、T3、T4时间点静息状态下HR在不同组间有差异 （P <0.05），在不同时间、变化趋势上无差异（P >0.05）。实验组与对照组分别有2例（5%）（平均用药量1片）和9 例（22.5%）（平均用药量2片）患者服用泰勒宁，经χ2 检验，差异有统计学意义（P <0.05）。实验组与对照组分别 有1例（2.5%）和6例（15%）出现恶心呕吐，经χ2 检验，差异有统计学意义（P <0.05）。结论 超声引导下FICB可 以安全有效的应用于老年髋部骨折患者的早期镇痛。

Abstract:

Objective To observe the effects of ultrasound-guided fascia iliaca compartment block on early analgesia in elderly patients with hip fracture. Methods Eighty elderly patients with hip fracture admitted to our hospital from January 2018 to December 2018 were selected and categorized randomly into group F and group N, with 40 cases in each group. In group F, patients were treated with ultrasound-guided fascia iliaca compartment block, and 0.3% ropivacaine was injected. In group N, 50 mg flurbiprofen was injected. The visual analogue scale (VAS) scores, mean arterial pressure (MAP) and heart rate (HR) right before (T0) and 30 min (T1), 1 h (T2), 6 h (T3) and 12 h (T4) after analgesia were evaluated. The incidences of adverse reactions including nausea and vomiting, drowsiness, urinary retention, hypotension, bleeding and hematoma at the puncture sites, and local anesthetics intoxication were compared between the two groups. The number of patients taking oxycodone and acetaminophen tablets and the dosages of the tablets were recorded and compared between the two groups. Results The VAS at rest (RVAS) and VAS after passive movement (PVAS) scores were different between the two groups and altered at different time points (T1, T2, T3 and T4) (P < 0.05), while there was no significant difference in the changing trends of the scores (P > 0.05). There was no difference in MAP at rest between the two groups or at different time points, and no significant difference was found in the changing trends of MAP at rest (P > 0.05). The MAP and HR after passive movement were different between the groups and altered at different time points with distinct changing trends (P < 0.05). The HR at rest was different between the groups (P < 0.05) but was not different at different time points (P > 0.05), and there was no difference in the changing trends of HR at rest (P > 0.05). Two patients in group F (5%) and nine patients in group N (22.5%) took oxycodone and acetaminophen tablets, and the average dosages were 1 tablet and 2 tablets, respectively (P < 0.05). As for the adverse reactions, one patient in group F (2.5%) and six patients in group N (15%) developed nausea and vomiting (P < 0.05). Conclusion Ultrasound-guided fascia iliaca compartment block can be safely used in elderly patients and provide effective early analgesia for hip fracture.