超声引导髂筋膜间隙阻滞对股骨粗隆间骨折患者体位改变时镇痛效果的临床研究

摘要

目的：探讨不同镇痛方式对股骨粗隆间骨折患者被动体位改变的镇痛效果。方法随机选择2014年1月＿2015年12月股骨粗隆间骨折择期手术的患者80例,美国麻醉医师协会麻醉风险评分(ASA) I~Ⅲ级。按照随机数表法将患者随机分为超声引导髂筋膜间隙阻滞组(A)和静脉氟比洛芬酯注射液组(B),每组40例。 A组在麻醉诱导前30 min在超声引导下行单次髂筋膜间隙阻滞,注入0.3％盐酸罗哌卡因30 mL。 B组患者静脉注射氟比洛芬酯注射液50 mg。评估各个时间点：完全阻滞成功后30 min和静脉氟比洛芬酯注射液用药后30 min (T1),病人搬动至手术床时(T2﹚,术后再次搬动病人至推车时(T3﹚被动活动的视觉模拟评分(VAS)和生命体征变化。结果 A组患者各时间点疼痛评分VAS分值分别为(3.5±0.72)、(4.8±0.76)、(2.8±0.73)分,均明显低于B组(6.0±0.78)、(7.9±0.80)、(5.2±0.68)分,差异有统计学意义(P﹤0.01﹚。 A组在T1时间点MAP(83.2±2.94)mmHg、T2时间点MAP(94.0±5.43)mmHg、T3时间点MAP (70.8±4.90﹚mmHg,均明显低于B组(85.7±2.94﹚、(103.0±3.81﹚、(82.1±3.86﹚mmHg,差异有统计学意义(P﹤0.05﹚。结论髂筋膜间隙阻滞相对于静脉用药对股骨粗隆间骨折手术患者镇痛效果更加显著且安全,对患者的搬运起到良好的镇痛作用。%Objective To explore the different analgesic methods on patients with intertrochanteric fractures the analgesic effect of passive position change.Methods Selected at random between January 2014 and December 2014, intertrochanteric fracture patients undergoing elective surgery in 80 cases, ASA I~Ⅲ level.According to the random indicator method pa-tients were randomly divided into Iliac fascia space block guided by ultrasound group (A) and Intravenous flurbiprofen ac-etate injection group (B), 40 cases in each group.30 minutes before anesthesia induction in ultrasound guided by A set of rows iliac fascia space block, A single injection of 0.3% hydrochloric acid, pp paid 30 mL. Group B patients with intra-venous flurbiprofen acetate injection 50 mg of dispute.Evaluation of each point in time, 30 minutes after injection drug completely block success and 30 minutes after intravenous medication of dispute flurbiprofen acetate injection (T1), move the bed to surgery patients (T2), move the patient to cart again (T3) after passive activity of visual analogue scale (VAS) and changes in vital signs. Results Patients of group A VAS pain score, each time point score(3.5±0.72 )、(4.8±0.76)、(2.8±0.73) points were significantly lower than group B (6.0±0.78)、(7.9±0.80)、(5.2±0.68)points,the difference was statistically signifi-cant(P< 0.01). Group A MAP in T1 time points (83.2±2.94)mmHg, T2 time point MAP (94.0±5.43) mmHg, T3 time point MAP(70.8±4.90﹚ mmHg, were significantly lower than that of group B(85.7±2.94﹚、(103.0±3.81﹚、(82.1±3.86﹚mmHg, the difference was statistically significant(P< 0.05). Conclusion Iliac fascia space block relative to intravenous drug use in pa-tients with intertrochanteric fracture surgery analgesia effect is more significant and safe, handle good analgesic effect for patients.