罗哌卡因单用及联合右美托咪定行超声下髂筋膜间隙阻滞在老年股骨近端骨折患者麻醉中的应用

Application of ultrasound-guided fascia iliaca compartment block with ropivacaine alone and ropivacaine combined with dexmedetomidine in anesthesia of elderly patients with proximal femoral fracture

中文关键词: 老年, 股骨近端骨折, 右美托咪定, 罗哌卡因, 髂筋膜间隙阻滞, 麻醉, 超声引导

英文关键词: elderly  proximal femoral fracture  dexmedetomidine  ropivacaine  fascia iliaca compartment block  anes-thesia  ultrasound guidance

中文摘要:

      目的 观察罗哌卡因单用及联合右美托咪定(Dex)行超声下髂筋膜间隙阻滞(FICB)在老年股骨近端骨折患者麻醉中的应用效果.方法 回顾性分析2020年3月-2023年11月亳州市中医院105例行股骨近端骨折手术老年患者的临床资料,根据围术期镇痛方式分为联合组(n=55)和罗哌卡因组(n=50).2组均在超声引导下行FICB,联合组患者注入Dex(1 μg/kg)联合0.375％罗哌卡因混合液30 mL,罗哌卡因组患者仅给0.375％罗哌卡因30 mL.术后均行舒芬太尼静脉自控镇痛(PCIA).比较2组术中围术期指标值[阻滞起效时间、阻滞消退时间、镇痛泵首次按压时间及累计按压次数]、舒芬太尼用量、镇痛效果[T0(阻滞前)、T1(麻醉诱导前)、T2(术后1 h)各时间点静息状态疼痛视觉模拟评分(VAS)及T3(术后12 h)、T4(术后24 h)和T5(术后48 h)运动状态VAS评分]、睡眠质量[采用里兹睡眠问卷评分量表(LSEQ)评估]、血流动力学指标[心率(HR)、平均动脉压(MAP)].结果 联合组阻滞起效时间及累计按压次数均少于罗哌卡因组,阻滞消退时间、镇痛泵首次按压时间长于罗哌卡因组(均P＜0.05).联合组舒芬太尼用量少于罗哌卡因组(P＜0.05).联合组高质量睡眠高于罗呢卡因组(90.％vs 72％,P＜0.05).2组LSEQ水平于组间、时间点差异均有统计学意义(P＜0.05),而交互无统计学意义(P＞0.05);2组治疗前LSEQ水平差异无统计学意义(P＞0.05),2组治疗后LSEQ水平均升高(P＜0.05),且联合组LSEQ水平高于罗哌卡因组(P＜0.05).2组各时间点HR差异均无统计学意义(P＞0.05).2组MAP水平于时间、交互差异均有统计学意义(P＜0.05).联合组T1时MAP水平低于罗哌卡因组(P＜0.05).结论 超声引导下Dex联合罗哌卡因行FICB麻醉,有利于减少老年股骨近端骨折患者术中阿片类药物的使用,改善患者的睡眠质量,具有一定的临床应用价值.

英文摘要:

      Objective To observe the application effects of ultrasound-guided fascia iliaca compartment block(FICB)with ropivacaine alone and ropivacaine combined with dexmedetomidine(Dex)in anesthesia of elderly patients with proximal femoral fracture.Methods The clinical data of 105 elderly patients who underwent proximal femoral fracture surgery in Tradi-tional Chinese Medicine Hospital of Bozhou City from March 2020 to November 2023 were retrospectively analyzed.According to different perioperative analgesia methods,patients were divided into combination group(n=55)and ropivacaine group(n=50).Both groups underwent FICB under ultrasound guidance.Patients in the combination group were injected with a mixture of Dex(1 μg/kg)and 0.375％ropivacaine(30 mL),while patients in the ropivacaine group were only given 0.375％ropiv-acaine(30 mL).After surgery,all patients were given sufentanil for patient-controlled intravenous analgesia(PCIA).The in-traoperative and perioperative indexes(block onset time,block disappearance time,first press time and cumulative press num-ber of the analgesic pump),sufentanil dosage,analgesic effect[the scores of Visual Analogue Scale(VAS)under rest state at T0(before block),T1(before anesthesia induction)and T2(1 h after surgery),and VAS scores under motion state at T3(12 h after surgery),T4(24 h after surgery)and T5(48 h after surgery)],sleep quality[Leeds Sleep Evaluation Question-naire(LSEQ)]were compared between the two groups.Hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP)].Results The block onset time and cumulative press number in the combination group were shorter or less than those in the ropivacaine group,and the block disappearance time and first press time of analgesic pump were longer than those in the ropivacaine group(all P＜0.05).The sufentanil dosage in the combination group was lower than that in the ropivacaine group(P＜0.05).There were significant differences in VAS scores under rest state in terms of inter-group dimension,time points di-mension and interaction dimension(P＜0.05).The VAS scores under rest state at T1-T2 in the combination group were lower than those in the ropivacaine group(P＜0.05).There were significant differences in VAS scores under motion state in terms of inter-group dimension and time points dimension(P＜0.05),but there was no difference in terms of interaction dimension(P＞0.05).The VAS scores under motion state at T3-T4 in the combination group were lower than those in the ropivacaine group(P＜0.05).The proportion of high-quality sleep in combination group was higher than that in ropivacatine group(90.00 vs 72.00％,P＜0.05).There was no significant difference in HR between the two groups at any time point(P＞0.05).There were significant differences in MAP in terms of time points dimension and interaction dimension(P＜0.05).MAP level at T1 in the combination group was lower than that in the ropivacaine group(P＜0.05).Conclusion Ultrasound-guided Dex combined with ropivacaine for FICB is beneficial to reduce intraoperative use of opioids and improve sleep quality in elderly patients with proximal femoral fracture.It has certain clinical application value.