老年全髋关节置换术高位髂筋膜阻滞的意义△

Significance of high fascia iliaca compartment block following total hip arthroplasty in elderly

摘要:

[目的] 探讨高位髂筋膜阻滞 （fascia iliaca compartment block, FICB） 在老年全髋关节置换术 （total hip arthroplasty, THA） 的意义。[方法] 140 例老年初次单侧 THA 患者随机分为两组，70 例采用高位 FICB 联合舒芬太尼患者自控静脉镇痛 （patient-controlled intravenous analgesia, PCIA）（复合组），另外 70 例采用单纯 PCIA （PCIA） 组。比较两组术后镇痛和临床资料。[结果]复合组术后 8、12、24 h 的 VAS 评分 [(2.3±0.4) vs (2.6±0.7), P=0.002; (2.7±0.5) vs (3.4±0.7), P＜0.001; (3.0±0.7) vs (3.4± 0.6), P＜0.001] 和 BCS 评分 [(3.3±0.5) vs (2.4±0.4), P＜0.001; (2.5±0.4) vs (1.9±0.5), P＜0.001; (2.9±0.6) vs (2.1±0.6), P＜0.001] 均显著优于 PCIA 组。复合组 48 h PCIA 总按压次数 [(5.2±2.2)次 vs (9.8±1.4) 次, P＜0.001] 和镇痛补救率 [5(7.1%) vs 18(25.7%), P=0.003] 均显著优于 PCIA 组。复合组术后第 1 d 和 3 d 的 MMSE 评分 [(8.7±2.1) vs (11.2±1.9), P＜0.001; (7.7±1.7) vs (8.7±1.8), P=0.001] 和 PSQI 评分 [(8.7±2.1) vs (11.2±1.9), P＜0.001; (7.7±1.7) vs (8.7±1.8), P=0.001] 均显著优于 PCIA 组。出院时复合组的 Harris 评分 [(80.6±5.6) vs (77.4±5.4), P=0.001] 显著优于 PCIA 组。复合组术后 5 d 头晕、恶心呕吐、便秘的发生率 [(2.9%) vs (12.9%), P=0.028; (4.3%) vs (18.6%), P=0.017; (8.6)% vs (25.7%), P=0.015] 显著低于 PCIA 组）。[结论]高位 FICB 联合 PCIA 可有效减轻 THA 的疼痛，提高术后的舒适度，降低术后谵妄和其他并发症的发生率，改善睡眠质量，促进髋关节功能的快速恢复。

Abstract:

[Objective] To explore the significance of fascia iliaca compartment block (FICB) after total hip arthroplasty (THA) in the el- derly. [Methods] A total of140 elderly patients who underwent primary unilateral THA were randomly divided into 2 groups. Of them, 70 pa- tients were treated with high FICB combined with patient-controlled intravenous analgesia (PCIA) (the compound group), while the other 70 patients were treated with PCIA only (the PCIA group). Postoperative analgesia and clinical data were compared between the two groups. [Results] The compound group proved significantly superior to the PCIA group in terms of VAS score [(2.3±0.4) vs (2.6±0.7), P=0.002; (2.7±0.5) vs (3.4±0.7), P＜0.001; (3.0±0.7) vs (3.4±0.6), P＜0.001] and BCS scores [(3.3±0.5) vs (2.4±0.4), P＜0.001; (2.5±0.4) vs (1.9±0.5) , P＜0.001; (2.9±0.6) vs (2.1±0.6), P＜0.001] 8, 12 and 24 hours postoperatively. In addition, the former was also significantly superior to the latter regard- ing to the total number of PCIA compressions within 48 hours [(5.2±2.2)times vs (9.8±1.4)times, P＜0.001] and additional analgesic usage rate [5(7.1%) vs 18(25.7%), P=0.003] . Furthermore, the compound group was significantly superior to the PCIA group in terms of MMSE scores [(8.7±2.1) vs (11.2±1.9), P＜0.001; (7.7±1.7) vs (8.7±1.8), P=0.001] and PSQI score [(8.7±2.1) vs (11.2±1.9), P＜0.001; (7.7±1.7) vs (8.7±1.8), P=0.001] 1 and 3 days after surgery. Moreover, the compound group got significant higher Harris score at discharge (P＜0.05) , with significantly lower complication rate, such as dizziness, nausea, vomiting and constipation within 5 days after operation than the PCIA group (P＜0.05). [Conclusion] High FICB combined with PCIA does effectively alleviate pain, improve postoperative comfort, reduce the in- cidence of postoperative delirium and other complications, improve sleep quality, enhance the rapid recovery of hip function after THA in the elderly.