布比卡因脂质体髋关节囊神经阻滞在老年股骨粗隆间骨折中的应用效果研究

Application of liposomal bupivacaine for pericapsular nerve group block in elderly patients with intertrochanteric fractures

摘要:

目的 分析布比卡因脂质体髋关节囊周围神经阻滞在老年股骨粗隆间骨折中的应用效果。方法 回顾性分析2022年6月—2023年5月宝鸡市中医医院收治的81例老年股骨粗隆间骨折患者的临床资料。患者均行蛛网膜下腔阻滞联合髋关节囊周围神经阻滞，按照用药的不同分为对照组40例（盐酸左布比卡因）和观察组41例（布比卡因脂质体）。比较两组不同时间点的静息和运动时的疼痛程度（VAS评分）、认知情况（MMSE评分）及血清疼痛介质指标（SP、β-EP、NO、5-HT）水平，以及两组的麻醉相关不良反应。结果 观察组和对照组术前、神经阻滞后30 min、术后6 h的运动和静息状态下VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P <0.05），观察组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组和对照组术前、术后24 h、48 h的MMSE评分比较，结果 ①不同时间点MMSE评分比较，差异有统计学意义（P <0.05）；②观察组与对照组MMSE评分比较，差异有统计学意义（P <0.05），观察组MMSE评分较高，相对认知情况较好；③两组MMSE评分变化趋势比较，差异有统计学意义（P <0.05）。观察组治疗前后SP、NO和5-HT的差值高于对照组（P <0.05），β-EP的差值低于对照组（P <0.05）。对照组与观察组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 老年股骨粗隆间骨折患者行布比卡因脂质体髋关节囊周围神经阻滞，可获得较好的镇痛效果，调节疼痛介质水平，且安全性较好。

Abstract:

Objective To analyze the efficacy of liposomal bupivacaine for pericapsular nerve group (PENG) block in elderly patients with intertrochanteric fractures.Methods A retrospective analysis was conducted on clinical data of 81 elderly patients with intertrochanteric fractures admitted to Baoji Hospital of Traditional Chinese Medicine from June 2022 to May 2023. All patients received combined spinal anesthesia and PENG block. They were divided into a control group (n = 40, treated with levobupivacaine hydrochloride) and an observation group (n =41, treated with liposomal bupivacaine).Results Outcomes included pain intensity at rest and during movement (VAS scores), cognitive status (MMSE scores), serum pain mediator levels [substance P （SP）, β-endorphin （β-EP）, nitric oxide （NO）, and 5-hydroxytryptamine （5-HT）], and anesthesia-related adverse reactions at different time points. Results For VAS scores (rest/movement): (1) Significant differences were observed across time points (preoperative, 30 min post-block, and 6 h postoperatively) in both groups (P < 0.05). (2) The observation group showed significantly lower VAS scores than the control group (P < 0.05), indicating superior analgesia. (3) Intergroup trends in VAS scores differed significantly (P < 0.05). For MMSE scores (preoperative, 24 h, and 48 h postoperatively): (1) Significant differences were observed across time points (P < 0.05). (2) The observation group had significantly higher MMSE scores than the control group (P < 0.05), reflecting better cognitive preservation. (3) Intergroup trends in MMSE scores differed significantly (P < 0.05). The observation group exhibited greater reductions in SP, NO, and 5-HT levels post-treatment compared to the control group (P < 0.05), with a smaller reduction in β-EP (P < 0.05). No significant difference in overall adverse reaction rates was observed between groups (P > 0.05).Conclusion Liposomal bupivacaine for PENG block in elderly intertrochanteric fracture patients provides effective analgesia, modulates pain-related mediators, and demonstrates favorable safety.