目的:比较老年髋关节置换术后患者静脉自控镇痛(PCIA)与腹股沟上韧带髂筋膜阻滞联合PCIA的效果。
方法:选择2019年6月至2021年6月行髋关节置换术的老年患者82例,随机分为观察组和对照组。对照组42例,包括18名男性和24名女性,年龄在60至78岁之间,平均(70.43±3.67)岁,28例股骨颈骨折和14例股骨头坏死,谁收到PCIA。研究组42例,包括20名男性和22名女性,年龄61至76岁,平均(69.68±3.74)岁,25例股骨颈骨折和17例股骨头坏死,患者接受腹股沟上韧带髂筋膜阻滞联合PCIA治疗。2h时疼痛视觉模拟评分(VAS)和Ramesay镇静评分,6h,12h,术后24h和48h进行评价。此外,术后48小时舒芬太尼总消耗量和PCIA按压总次数的随访结果,手术后第一次着陆,住院时间,不良反应的发生率,观察两组患者的镇痛满意度。
结果:所有患者随访9~24个月,平均(13.85±2.67)个月。两组手术时间、术中出血量比较差异无统计学意义(P>0.05)。两组术后2hVAS评分差异无统计学意义(P>0.05)。和研究组6小时的VAS,12h,观察组术后24h和48h均低于对照组(P<0.05)。研究组2h时的Ramesay镇静评分,术后6h和12h治疗组高于对照组(P<0.05),两组患者术后24h、48hRamesay评分差异无统计学意义(P>0.05)。研究组术后48h内舒芬太尼用量低于对照组(P<0.05),PCIA压缩时间低于对照组(P<0.05),首次着陆时间早于对照组(P<0.05)。住院时间无显著差异,不良反应发生率,两组并发症发生率比较(P>0.05)。研究组镇痛满意度高于对照组(P<0.05)。
结论:腹股沟韧带髂上筋膜阻滞联合PCIA在老年髋关节置换术后具有明显的镇痛、镇静作用。它可以减少舒芬太尼的使用量和PCIA按压的总数,这有利于患者下床的早期活动,提高镇痛满意度。
OBJECTIVE: To compare the effect of patient-controlled intravenous analgesia(PCIA) and superior inguinal ligament iliac fascia block combined with PCIA after hip replacement in the elderly.
METHODS: Total of 82 elderly patients were treated with hip arthroplasty from June 2019 to June 2021 and randomly divided into observation group and control group. There were 42 patients in control group, including 18 males and 24 females, aged from 60 to 78 years old with an average of (70.43±3.67) years old, 28 femoral neck fractures and 14 femoral head necrosis, who received PCIA. The study group consisted of 42 cases, including 20 males and 22 females, aged from 61 to 76 years old with an average of (69.68±3.74) years old, 25 femoral neck fractures and 17 femoral head necrosis, who received superior inguinal ligament iliac fascia block combined with PCIA. Pain visual analogue scale (VAS) and Ramesay sedation scores at 2 h, 6 h, 12 h, 24 h and 48 h after operation were evaluated. In addition, the follow-up results of the total consumption of sufentanil and the total number of PCIA compressions at 48 hours after operation, the first time of landing after surgery, the time of hospital stay, the incidence of adverse reactions, the satisfaction with analgesia of two groups were observed.
RESULTS: All patients were followed up for 9 to 24 months with an average of(13.85±2.67) months. There was no significant difference in operation time and intraoperative bleeding between two groups (P>0.05). There was no difference in VAS between two groups at 2 hours after operation (P>0.05), and the VAS of the study group at 6 h, 12 h, 24 h and 48 h after operation were lower than those of the control group(P<0.05). The Ramesay sedation scores of the study group at 2 h, 6 h and 12 h after operation were higher than those of the control group(P<0.05), and there were no differences in Ramesay score between two groups at 24 h and 48 h after operation (P>0.05). The consumption of sufentanil in the study group within 48 hours after operation was lower than that in the control group (P<0.05), and PCIA compression times were lower than those in the control group(P<0.05), and the time of first landing was earlier than that in the control group(P<0.05). There was no significant difference in hospital stay, adverse reaction rate, complications between two groups (P>0.05). The satisfaction of analgesia in the study group was higher than that in the control group (P<0.05).
CONCLUSIONS: Superior iliac fascia block of inguinal ligament combined with PCIA has significant analgesic and sedative effects after hip arthroplasty in the elderly. It can reduce the amount of sufentanil used and the total number of PCIA compressions, which is conducive to the early activity of patients out of bed, improve the satisfaction of analgesia.