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超声引导下不同阻滞方法对髋部骨折患者腰麻摆放体位时的影响*
作者:刘贝贝 单子宝# 李慧 
单位:济宁医学院附属日照市中医医院麻醉科 山东 日照 276800 
关键词:髂筋膜间隙阻滞 神经阻滞 髋部骨折 
分类号:R 614.4
出版年,卷(期):页码:2023,40(6):621-623
摘要:

 

 
摘要:目的 比较超声引导下不同阻滞方法对髋部骨折患者腰麻摆放体位时的影响。方法 选择2020年3—12月于我院治疗的髋部骨折患者60例,将其均分为采用传统髂筋膜间隙阻滞(FICB)的低位髂筋膜阻滞组(L组)30例和采用改良的高位髂筋膜间隙阻滞的高位髂筋膜阻滞组(H组)30例。阻滞操作20 min后摆放麻醉体位。比较两组入室后(T0)、阻滞操作后10 min(T1)和20 min(T2)、椎管内麻醉穿刺前变换体位时(T3)的VAS评分,以及神经阻滞操作时间、神经阻滞显效时间、椎管内麻醉时间及相关并发症情况。结果 与T0比较,两组T1~T3的VAS评分均明显降低,且H组明显低于L组,组间比较差异均有统计学意义(F=123.040、5.628,均P<0.05);H组的神经阻滞操作时间长于L组、神经阻滞显效时间短于L组,组间比较差异均有统计学意义(t=2.037、2.467,均P<0.05);两组椎管内麻醉时间比较,差异无统计学意义(t=0.240,P>0.05);两组围术期均未发生出血、局麻药物中毒等并发症。结论 高位髂筋膜阻滞的效果优于传统髂筋膜阻滞,且显效更快,具有临床应用优势。

 Abstract:Objective To compare the effect of different ultrasound-guided block methods in the posture of lumbar anesthesia for patients with hip fracture. Methods A total of sixty patients with hip fracture treated in our hospital from March to December 2020 were selected, were randomly divided into two groups (n=30 each): low fascia iliaca compartment block (FICB) group (Group L) with traditional FICB and high FICB group (Group H) with modified high FICB. The anesthesia position was set after 20 min of block operation. The VAS scores after admission (T0), 10 min (T1) and 20 min (T2) after the block operation, and at the time of changing the position before puncture of intradural anesthesia (T3) were compared between the two groups, as well as the time of nerve block operation, the time of apparent effect of nerve block, the time of intradural anesthesia, and the related complications. Results Compared with T0, the VAS scores from T1 to T3 of both groups were significantly lower, and Group H was significantly lower than Group L, and the differences were statistically significant when comparing the groups (F=123.040, 5.628, both P<0.05); the time of nerve block operation in Group H was longer than that of Group L, and the time of nerve block efficacy was shorter than that of Group L, and the differences were statistically significant when comparing the groups (t=2.037, 2.467, both P<0.05); the difference between the two groups was not statistically significant when comparing the time of intravertebral anesthesia (t=0.240, P>0.05); no perioperative complications, such as bleeding and local anesthetic drug toxicity, occurred in the two groups. Conclusion High FICB is superior to traditional FICB and has a faster effect, which is advantageous for clinical application.

基金项目:
?基金项目:2019年度济宁医学院教师科研扶持基金(项目编号: JYFC2019FKJ063)
作者简介:
参考文献:

 参考文献

[1] 李丽娜.超声引导髂筋膜阻滞对老年女性股骨近端骨折麻醉的影响[J].影像研究与医学应用,2019,3(24):207-208.
[2] 嵇家燕.超声引导下髂筋膜间隙阻滞对全麻下老年髋关节置换患者术中应激水平及术后疼痛程度的影响[J].系统医学,2020,5(5):40-42,94.
[3] Hebbard P,Ivanusic J,Sha S. Ultrasound-guided supra-inguinal fascia iliaca block:a cadaveric evaluation of a novel approach[J]. Anaesthesia,2011,66(4):300-305.
[4] 王皓,徐洪刚.超声引导高位髂筋膜间隙阻滞在老年髋部骨折手术中的应用[J].锦州医科大学学报,2019,40(3):63-66.
[5] 于健,朱春华,季雅君,等.不同入路髂筋膜间隙阻滞用于全髋关节置换术老年患者术后镇痛效果的比较[J].中华麻醉学杂志,2019,39(10):1224-1227.
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