“领结征”髂筋膜间隙阻滞联合闭孔神经阻滞在老年髋部骨折患者早期镇痛中的临床应用-现代医学

“领结征”髂筋膜间隙阻滞联合闭孔神经阻滞在老年髋部骨折患者早期镇痛中的临床应用

单位：1. 阜宁县人民医院麻醉科, 江苏阜宁 224400;
2. 南京医科大学附属苏州医院西区/苏州科技城医院麻醉科, 江苏苏州 215153;
3. 南京市栖霞区医院药剂科, 江苏南京 210046

分类号：R614.4

出版年·卷·期（页码）：2019·47·第七期（812-815）

摘要：

目的：评价“领结征”髂筋膜间隙阻滞联合超声引导下近端筋膜间闭孔神经阻滞对老年髋部骨折患者早期镇痛的有效性及安全性。方法：选择阜宁县人民医院及苏州科技城医院2017年3月至2018年3月髋部骨折的老年患者50例（年龄≥70岁）为研究对象，患者均神志正常，无复合性损伤。随机分为“领结征”髂筋膜间隙阻滞联合超声引导下近端筋膜间闭孔神经阻滞组（A组）和口服盐酸曲马多缓释片组（B组），每组25例。分别记录两组患者镇痛前即刻（T₀），镇痛后20 min（T₁）、1 h（T₂）、3 h（T₃）静态和动态的视觉模拟评分（VAS）、平均动脉压（MAP）和心率（HR），同时观察镇痛期间患者是否出现头晕恶心、穿刺部位血肿和药物中毒等情况。结果：与B组比较，A组在T₁、T₂、T₃时间点静态VAS和动态的VAS、MAP和HR均降低，差异有统计学意义（P<0.05或P<0.01）。A组无穿刺部位血肿和局部麻药中毒等发生。结论：“领结征”髂筋膜间隙阻滞联合超声引导下近端筋膜间闭孔神经阻滞在老年髋部骨折患者早期镇痛中安全有效，便于推广。

Objective:To evaluate the efficacy and safety of "BTS" fascia iliaca compartment block(FICB) combined with ultrasound-guided obturator nerve block(ONB) for early analgesia in elderly patients with hip fracture. Methods:Fifty elderly patients (age ≥ 70 years) with hip fractures were selected as the reseach object from Department of Orthopaedics of Funing People's Hospital and Suzhou Science & Technology Town Hospital during March 2017 to March 2018. All of them were sane and without complex injury. The patients were treated by"BTS" FICB combined with ultrasound-guided proximal interfascial ONB (group A) and oral tramadol hydrochloride sustained released tablets (group B)randomly, 25 patients in each group. The instant(T₀) before analgesia,20 min(T₁), 1 h (T₂) and 3 h (T₃) after analgesiathe static and dynamic visual analogue scale (VAS) scores, mean arterial pressure (MAP) and heart rate (HR) were recorded in the both groups. At the same time, whetherdizziness or nausea, hematoma at the puncture site and drug poisoning, etc. during the analgesia were observed. Results:Compared with group B, group A had a lowered static VAS scores and dynamic VAS scores, MAP and HR at T₁, T₂, and T₃, and the differences were statistically significant (P<0.05 or P<0.01). No hematoma at the puncture site or local anesthetic poisoning occurred in group A.Conclusions:"BTS" FICB combined with ultrasound-guided proximal interfascial ONB for early analgesia in elderly patients with hip fracture is safe, effective, and easy to spread.

参考文献：

[1] KUMIE F T,GEBREMEDHN E G,TAWUYE H Y.Efficacy of fascia iliaca compartment nerve block as part of multimodal analgesia after surgery for femoral bone fracture[J].World J Emerg Med,2015,6(2):142-146.
[2] MCRAE P J,BENDALL J C,MADIGAN V,et al.Paramedic-performed fascia iliaca compartment block for femoral fractures:A controlled trial[J].J Emerg Med,2015,48(5):581-589.
[3] SWENSON J D,BROWN N A.Evaluation of a new fenestrated needle for ultrasound-guided fascia iliaca block[J].J Clin Anesth,2007,19(3):175-179.
[4] MURGATROYD H,FORERO M,CHIN K J.The efficacy of ultrasound-guided fascia iliaca block in hip surgery:a question of technique?[J].Reg Anesth Pain Med,2013,38(5):459-460.
[5] VAUGHAN B,MANLEY M,STEWART D,et al.Distal injection site may explain lack of analgesia from fascia iliaca block for total hip[J].Reg Anesth Pain Med,2013,38(6):556-557.
[6] SINGH H,JONES D.Hourglass-pattern recognition simplifies fascia iliaca compartment block[J].Reg Anesth Pain Med,2013,38(5):467-468.
[7] SWENSON J D,DAVIS J J,STREAM J O,et al.Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament:the pattern of distribution and effects on the obturator nerve[J].J Clin Anesth,2015,27(8):652-657.
[8] MORAU D,LOPEZ S,BIBOULET P,et al.Comparison of continuous 3-in-1 and fascia iliaca compartment blocks for postoperative analgesia:feasibility,catheter migration,distribution of sensory block,and analgesic efficacy[J].Reg Anesth Pain Med,2003,28(4):309-314.

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