超声引导下连续髂筋膜间隙阻滞复合右美托咪定在老年患者髌骨骨折手术中的应用
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摘要
目的探讨超声引导下连续髂筋膜间隙阻滞(FICB)复合右美托咪定在老年患者髌骨骨折手术中的应用效果及安全性。方法将60例择期行手术治疗的老年髌骨骨折患者随机分为对照组与研究组,每组各30例。对照组患者行全身麻醉,术毕静脉自控镇痛;研究组患者在右美托咪定镇静后行超声引导下FICB,术后神经自控镇痛。记录并比较两组患者在麻醉前(T_1)、切皮时(T_2)、手术开始后10 min(T_3)、20 min(T_4)、术毕时(T_5)的HR、平均动脉压(MAP)及指脉血氧饱和度(SpO_2)。比较两组患者术后3 h、6 h、12 h、24 h、48 h的疼痛视觉模拟量表(VAS)评分、术后48 h不良反应发生情况及患者总满意率。结果研究组T_2、T_3时的MAP及HR均低于对照组,但两组的SpO_2水平比较,差异无统计学意义(P> 0. 05)。研究组术后48 h恶心及高血压发生率均低于对照组(P <0. 05)。研究组患者总满意率高于对照组(P <0. 05)。结论超声引导下连续FICB复合右美托咪定可以安全、有效地应用于老年患者髌骨骨折手术,有利于保持患者血流动力学稳定,并提供良好的术后镇痛和减少术后不良反应发生。
Objective To investigate the effect and safety of ultrasound-guided continuous fascia iliaca compartment block( FICB) combined with dexmedetomidine in elderly patients undergoing patellar fracture surgery.Methods Sixty elderly patients with patellar fracture undergoing elective surgical treatment were randomly divided into control group or study group,with 30 cases in each group. The control group received general anesthesia and intravenous self-controlled analgesia after operation,while the study group received ultrasound-guided FICB after sedation with dexmedetomidine and self-controlled neurological analgesia after operation. Before anesthesia( T_1),at skin incision( T_2),10 minutes after operation( T_3),20 minutes after operation( T_4),and at the end of operation( T_5),HR,mean arterial pressure( MAP) and finger pulse oxygen saturation( SpO_2) were recorded and compared between the two groups. The pain visual analogue scale( VAS) scores of 3,6,12,24 and 48 hours after operation,and incidence of adverse reactions and total satisfaction rate of patients 48 hours after operation were compared between the two groups.Results MAP and HR were lower in the study group than in the control group at T_2 and T_3( all P < 0. 05),but no significant difference existed in the level of SPO_2 between the two groups( P > 0. 05). Incidences of nausea and hypertension 48 hours after operation were lower in the study group than in the control group( P < 0. 05). Total satisfaction rate of the study group was higher than that of the control group( P < 0. 05). Conclusion Ultrasound-guided continuous FICB combined with dexmedetomidine can be safely and effectively applied to patellar fracture surgery in elderly patients,which is conducive to maintaining hemodynamic stability,providing good postoperative analgesia,and reducing the occurrence of adverse reactions.
Objective To investigate the effect and safety of ultrasound-guided continuous fascia iliaca compartment block( FICB) combined with dexmedetomidine in elderly patients undergoing patellar fracture surgery.Methods Sixty elderly patients with patellar fracture undergoing elective surgical treatment were randomly divided into control group or study group,with 30 cases in each group. The control group received general anesthesia and intravenous self-controlled analgesia after operation,while the study group received ultrasound-guided FICB after sedation with dexmedetomidine and self-controlled neurological analgesia after operation. Before anesthesia( T_1),at skin incision( T_2),10 minutes after operation( T_3),20 minutes after operation( T_4),and at the end of operation( T_5),HR,mean arterial pressure( MAP) and finger pulse oxygen saturation( SpO_2) were recorded and compared between the two groups. The pain visual analogue scale( VAS) scores of 3,6,12,24 and 48 hours after operation,and incidence of adverse reactions and total satisfaction rate of patients 48 hours after operation were compared between the two groups.Results MAP and HR were lower in the study group than in the control group at T_2 and T_3( all P < 0. 05),but no significant difference existed in the level of SPO_2 between the two groups( P > 0. 05). Incidences of nausea and hypertension 48 hours after operation were lower in the study group than in the control group( P < 0. 05). Total satisfaction rate of the study group was higher than that of the control group( P < 0. 05). Conclusion Ultrasound-guided continuous FICB combined with dexmedetomidine can be safely and effectively applied to patellar fracture surgery in elderly patients,which is conducive to maintaining hemodynamic stability,providing good postoperative analgesia,and reducing the occurrence of adverse reactions.
引文
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[2]Williams H,Paringe V,Shenoy S,et al.Standard preoperative analgesia with or without fascia iliaca compartment block for femoral neck fractures[J].J Orthop Surg(Hong Kong),2016,24(1):31-35.
[3]Desmet M,Vermeylen K,Van Herreweghe I,et al.A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty[J].Reg Anesth Pain Med,2017,42(3):327-333.
[4]Van Waesberghe J,Stevanovic A,Rossaint R,et al.General vs.neuraxial anaesthesia in hip fracture patients:a systematic review and meta-analysis[J].BMC Anesthesiol,2017,17(1):87.
[5]孙婷婷,陶勇,林辉,等.确切股神经阻滞技术在髌骨骨折麻醉及术后镇痛中的应用[J].实用临床医药杂志,2015,19(17):100-101,104.
[6]武乾峰.神经刺激仪引导下股神经阻滞和腰麻用于髌骨骨折切开复位内固定术的比较[J].包头医学院学报,2016,2(2):52-54.
[7]Kassam AM,Gough AT,Davies J,et al.Can we reduce morphine use in elderly,proximal femoral fracture patients using a fascia iliaca block?[J].Geriatr Nurs,2018,39(1):84-87.
[8]Zhang P,Li J,Song Y,et al.The efficiency and safety of fascia iliaca block for pain control after total joint arthroplasty:a meta-analysis[J].Medicine(Baltimore),2017,96(15):e6592.
[9]Zhao ZY,Gan JH,Liu JB,et al.Clinical evaluation of combination of dexmedetomidine and midazolam vs.dexmedetomidinealone for sedation during spinal anesthesia[J].Saudi J Biol Sci,2017,24(8):1 758-1 762.
[10]Tonooka Y,Sunada K.Dexmedetomidine enhances the pulpal anesthetic effect of lidocaine:a pilot study[J].Anesth Prog,2018,65(1):38-43.
[11]邓金和,贺繁荣,招伟贤.不同剂量右美托咪啶对60岁以上髋部手术患者的脑保护效应[J].实用医学杂志,2017,33(1):115-117.
[12]Lin TF,Yeh YC,Lin FS,et al.Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia[J].Br J Anaesth,2009,102(1):117-122.