摘要
目的比较超声引导罗哌卡因复合右美托咪定两种入路髂筋膜院前区域阻滞对老年髋部骨折患者疼痛控制及快速康复的影响。方法选取2018年7月至2019年11月资阳市人民医院收治的髋部骨折老年患者56例,所有患者在该院急诊科或骨科就诊办理住院前均使用罗哌卡因复合右美托咪定镇痛,依据入路方式分成两组,每组28例。对照组采用腹股沟韧带下传统入路方式,试验组采用腹股沟韧带上“领结征”入路方式。比较两组阻滞后不同时间点的阻滞成功率和疼痛视觉模拟评分(VAS)。比较两组手术前的全身相关情况:包括睡眠情况及并发症情况。结果试验组阻滞后不同时间点的阻滞成功率均高于对照组,差异有统计学意义(P<0.05)。两组患者阻滞后不同时间点VAS评分均呈下降趋势,差异有统计学意义(P<0.05);试验组阻滞后不同时间点VAS评分下降幅度大于对照组,差异有统计学意义(P<0.05)。试验组睡眠节律正常比率和睡眠质量量化评分高于对照组,差异有统计学意义(P<0.05),试验组谵妄发生率率低于对照组,差异有统计学意义(P<0.05)。结论院前超声引导腹股沟韧带上“领结征”入路髂筋膜阻滞,可明显提高阻滞成功率,降低患者术前的疼痛情况,改善患者在治疗过程中的全身状况。
Objective To compare the effect of two ultrasound-guided approaches of prehospital iliac fascia block with ropivacaine combined with dexmedetomidine on the pain control and rapid rehabilitation in elderly patients with hip fracture.Methods A total of 56 elderly patients with hip fracture admitted to Ziyang People's Hospital from July of 2018 to November of 2019 were selected.All those patients were treated with ropivacaine combined with dexmedetomidine for analgesia before hospitalization in Emergency Department or Department of Orthopedics and were divided into the control group(n=28)and experimental group(n=28)according to different approaches of prehospital iliac fascia block.The control group was treated with the traditional approach under the inguinal ligament,while the experimental group was treated with the“bow-tie sign”approach over the inguinal ligament.The block success rates and visual analogue scale(VAS)scores at different time points after block were compared between the two groups.The overall conditions including sleep condition and complications before the operation in the two groups were compared.Results The block success rates at different time points after block in the experimental group were significantly higher than those in the control group(P<0.05).The VAS scores at different time points after block in both groups showed descending trends and the differences were statistically significant(P<0.05).The decreasing degrees of the VAS scores at different time points after block in the experimental group were significantly greater than those in the control group(P<0.05).The normal rate of sleep rhythm and the quantitative score of sleep quality in the study group were significantly higher than those in the control group(P<0.05).The incidence of delirium in the study group was significantly lower than that in the control group(P<0.05).Conclusion The ultrasound-guided“bow-tie sign”approach over the inguinal ligament for the prehospital iliac fascia block can significantly improve the block success rate,reduce the preoperative pain,and improve the overall conditions in elderly patients with hip fracture.
作者
刘信全
唐连强
艾华东
顾治芬
熊伟
王付建
唐光明
屈新民
Liu Xinquan;Tang Lianqiang;Ai Huadong;Gu Zhifen;Xiong Wei;Wang Fujian;Tang Guangming;Qu Xinming(Department of Anesthesiology, Ziyang People's Hospital, Ziyang 641300, China;Emergency Department, Ziyang People's Hospital, Ziyang 641300, China;Department of Orthopedics, Ziyang People's Hospital, Ziyang 641300, China;Department of Anesthesiology, Anyue Hospital of Traditional Chinese Medicine, Anyue 642350, China)
出处
《成都医学院学报》
CAS
2021年第1期42-45,共4页
Journal of Chengdu Medical College
基金
资阳市科技知识产权局项目(No:Zykjjsc20-2018-23,No:Zykjjsc20-2017-13)。
