【摘要】 目的探讨连续髂筋膜间隙阻滞(fascia iliac compartment block,FICB)镇痛对老年股骨粗隆间骨折手术患者的术后镇痛效果及应激水平的影响。方法筛选2019年6月-2020年6月泰兴市人民医院收治的股骨粗隆间骨折手术患者80例,年龄65～89岁,ASA Ⅰ—Ⅲ级。利用随机数表法将患者分为2组:0.1%罗哌卡因连续FICB组(A组)和0.2%罗哌卡因连续FICB组(B组),每组40例。记录术后6、8、12和24h时的患者的静息和运动时视觉模拟(visual analogue score,VAS)评分、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)及血氧饱和度(oxygen saturation,SpO2);在术前 Id 和术后 1、2、3 d,采用简易精神状态量表(mini-mental state examination,MMSE)评估患者的认知状态,采用ELISA法检测血清褪黑素水平;记录术后24 h内不良反应发生情况、补救镇痛次数、首次下床活动时间和住院天数等。结果 B组术后6h、8h、12h、24h静息和活动时VAS评分明显低于A组(P<0.05);2组术后各时点的HR、MAP及SpO2差异无统计学意义(P>0.05);2组术后MMSM评分和血清褪黑素水平均明显下降(P<0.05),但B组术后1 d及术后2 d时MMSE评分和血清褪黑素水平明显高于A组(P<0.05);术后24 h内,B组恶心、呕吐及眩晕的发生率明显低于A组(P<0.05);B组曲马多补救镇痛率、首次下床活动时间和住院时间均明显低于A组(P<0.05)。结论 0.2%罗哌卡因连续FICB对老年股骨粗隆间骨折患者可以提供更完善的术后镇痛效果,有利于减轻术后应激反应。更多还原

【Abstract】 Objective To explore the effects of continuous fascia iliac compartment block(FICB) on postoperative analgesia and stress level in elderly patients with femoral intertrochanteric fracture.Methods 80 patients with femoral intertrochanteric fracture who were admitted to Taixing People’s Hospital from June 2019 to June 2020,aged 65-89 years old,ASA grade Ⅰ～Ⅲ,were selected.The patients were divided into 2 groups by random number table:0.1% ropivacaine continuous FICB group(group A) and 0.2% ropivacaine continuous FICB group(group B),with 40 cases in each group.The visual analogue scale(VAS) score at rest and exercise,mean arterial pressure(MAP) and oxygen saturation(SpOz) were recorded at 6,8,12 and 24 hours after operation.On 1 d before operation and 1,2,3 d after operation,the cognitive function of the patient was assessed by Mini-Mental State Examination(MMSE),and the serum melatonin level was detected by ELISA.The incidence of adverse reactions within 24 hours after operation,the number of rescue analgesia,the time of getting out of bed for the first time and the length of hospital stay after operation were recorded.Results The VAS score at rest and exercise at 6,8,12,and 24 hours after operation of the group B were lower than those of the group A(P<0.05).There was no difference in HR,MAP and SpO2 between the two groups at various points after operation(P<0.05).On the 1 st and 2 nd day after operation,MMSE score and serum melatonin level of both groups were significantly decreased(P<0.05),but MMSE score and serum melatonin level of the group B were significantly higher than those of group A(P<0.05).Within 24 hours after operation,the incidence of nausea,vomiting and vertigo of the group B was significantly lower than that of the group A(P<0.05).The rescue analgesia rate of tramadol,the first time out of bed and the length of hospital stay of group B were significantly lower than those of group A(P<0.05).Conclusion 0.2% ropivacaine continuous FICB can provide better postoperative analgesic effect in elderly patients with femoral intertrochanteric fractures,which is beneficial to reduce postoperative stress response.更多还原