| 詹丹丹,李向南,陆荣祥,等.不同浓度罗哌卡因行髋关节囊周围神经阻滞缓解老年股骨粗隆间骨折患者术前疼痛的效果探讨[J].中国临床保健杂志,2024,27(3):351-355. |
| 不同浓度罗哌卡因行髋关节囊周围神经阻滞缓解老年股骨粗隆间骨折患者术前疼痛的效果探讨 |
| Comparison of different concentrations of ropivacaine pericapsular nerve group block of hip joint in preoperative analgesia with intertrochanteric femoral fractures in the elderly |
| 投稿时间：2024-03-17 |
| DOI：10.3969/J.issn.1672-6790.2024.03.015 |
| 中文关键词: 股骨骨折 疼痛 神经传导阻滞 罗哌卡因 老年人 |
| 英文关键词: Femoral fractures Pain Nerve block Ropivacaine Aged 〖FL |
| 基金项目:江苏省中医药科技发展项目(YB2020081)；江苏省盐城市卫生健康委员会医学科研立项项目(YK2023022) |
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| 中文摘要: |
| 目的 探讨不同浓度罗哌卡因超声引导下髋关节囊周围神经(PENG)阻滞用于缓解老年股骨粗隆间骨折患者麻醉前体位性疼痛的效果和安全性。方法 纳入2022年3月至2023年3月盐城市第三人民医院股骨粗隆间骨折择期于椎管内麻醉下行股骨近端防旋髓内钉内固定治疗的60例患者,根据罗哌卡因的浓度分为3组:0.2%罗哌卡因20 mL组(L组),0.375%罗哌卡因20 mL组(M组),0.75%罗哌卡因20 mL组(H组),每组20例。在椎管内麻醉体位变动前,进行超声引导下PENG阻滞。记录阻滞前(T0)、阻滞后5 min(T1)、阻滞后10 min(T2)、阻滞后15 min(T3)、阻滞后20 min(T4)静息和动态(被动直腿抬高和内收)视觉模拟评分(VAS),记录体位摆放时的VAS评分。记录椎管内麻醉体位质量评分,补救镇痛的例数,患者满意率,术后6 h股四头肌肌力分级以及不良反应的发生情况。结果 T2、T3时H组静息VAS评分低于L组(P<0.05)；T1、T2、T3时H组被动直腿抬高15°的VAS评分低于L组和M组患者(P<0.05)；T4时M组和H组被动直腿抬高15°的VAS评分低于L组患者(P<0.05)。T2、T3时H组内收的VAS评分低于M组和L组(P<0.05)；T4时M组和H组内收的VAS评分低于L组(P<0.05)。M组和H组椎管内麻醉体位摆放时的VAS评分低于L组(P<0.05)。M组和H组体位质量评分均优于L组(P<0.05)。L组术后6 h股四头肌肌力优于H组(P<0.05)。结论 0.375%罗哌卡因PENG阻滞减轻了股骨粗隆间骨折患者体位摆放疼痛,提高了患者体位摆放质量和患者满意率,对股四头肌肌力影响较小,不良反应较少。 |
| 英文摘要: |
| Objective To explore the efficacy and safety of different ropivacaine ultrasound-guided hip pericapsular nerve block concentrations in relieving anesthesia preposition pain in elderly patients with intertrochanteric femoral fractures.Methods Sixty elderly patients with femoral intertrochanteric fracture treated with intravertebral anesthesia and proximal femoral nail antirotation at the Third People′s Hospital of Yancheng City from March 2022 to March 2023 were selected.According to the concentration of ropivacaine,they were divided into three groups:0.2% ropivacaine 20 mL group (Group L),0.375% ropivacaine 20 mL group (Group M),0.75% ropivacaine 20 mL group (Group H),20 cases in each group.Ultrasound-guided nerve block before the change of the position of intravertebral anesthesia in all patients.Static and dynamic(passive straight leg lift and adduction) visual analog scale (VAS) scores were recorded before nerve block(T0),5 min(T1),10 min(T2),15 min(T3),20 min(T4) after nerve block;the VAS score was recorded when the position was placed.The position quality score,the number of remedied analgesia,patient satisfaction,muscle strength grading of quadriceps femoris 6 h after surgery and the occurrence of adverse reactions were recorded.Results The static VAS scores of Group H at T2 and T3 were lower than those of Group L(P<0.05).At T1,T2,and T3,the VAS scores of the passive straight leg lift by 15 degrees of Group H was lower than that of Group L and Group M(P<0.05).At T4,the VAS scores of the passive straight leg lift by 15 degrees of Group M and Group H were lower than that of Group L(P<0.05).At T2 and T3,the VAS scores of adduction of Group H was lower than that in Group M and Group L(P<0.05).At T4,the VAS scores of adduction of Group M and Group H was lower than that of Group L(P<0.05).The static and dynamic VAS scores in each group at different detection time points have significant differences (P<0.05).The VAS scores of the intrathecal anesthesia position of Group M and Group H was lower than that of Group L(P<0.05).The position quality scores of Group M and Group H was better than those of Group L(P<0.05).The femoral quadriceps muscle strength graded of Group L 6 hours after surgery was better than Group H(P<0.05).Conclusions 0.375% ropivacaine PENG block alleviates the pain of position placement in the spinal canal of patients with femoral intertrochanteric fractures,improves the quality of position placement and patient satisfaction,with less impact on femoral quadriceps muscle strength and less adverse reactions. |
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