| 摘要: |
| ［摘要］ 目的 观察多模式镇痛下持续髂筋膜间隙阻滞在全麻骨科手术中的应用效果。方法 选取2019年5月至2021年5月广东医科大学附属医院骨科收治的手术患者100例，采用随机数字表法将其分为观察组和对照组，每组50例。对照组实施传统的持续髂筋膜间隙阻滞，观察组实施多模式镇痛下持续髂筋膜间隙阻滞。比较两组血流动力学［收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）］、手术相关指标（手术时间、术后苏醒时间、意识恢复清醒时间）、认知功能［简易精神状态检查量表（MMSE）评分］、镇痛效果［视觉模拟评分量表（VAS）评分］、镇静效果（Ramsay评分）以及不良反应发生情况。结果 两组麻醉开始（T1）时点与麻醉开始前（T0）时点SBP、DBP、MAP、HR无明显变化，差异无统计学意义（P>0.05），麻醉30 min（T2）、手术结束（T3）时点各指标水平均升高，但在术后12 h（T4）时点回降，基本接近T0时点水平，观察组升高浮动趋势较小，恢复较快（P<0.05）。观察组术后苏醒时间、意识恢复清醒时间显著短于对照组（P<0.05）。两组术后24 h MMSE评分均降低，观察组降低幅度较小（P<0.05）。术后2 h、12 h、24 h、48 h，两组VAS评分、Ramsay评分呈下降趋势，且观察组低于对照组（P<0.05）。两组不良反应率比较差异无统计学意义（P>0.05）。结论 多模式镇痛下持续髂筋膜间隙阻滞辅助骨科全麻手术有利于稳定血流动力学，提高镇静镇痛效果，促进术后苏醒，改善术后认知功能，且不良反应率较低。 |
| 关键词: 持续髂筋膜间隙阻滞 多模式镇痛 血流动力学 认知功能 |
| DOI：10.3969/j.issn.1674-3806.2022.03.14 |
| 分类号:R 614.2+4 |
| 基金项目: |
|
| Observation on the application effect of continuous iliac fascial space block under multimodal analgesia on orthopedic surgery under general anesthesia |
|
LIANG Guang-bin, CHEN Cui-ping, YAN Zhen-yi, et al.
|
|
Department of Anesthesiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
|
| Abstract: |
| ［Abstract］ Objective To observe the application effect of continuous iliac fascial space block under multimodal analgesia on orthopedic surgery under general anesthesia. Methods A total of 100 patients undergoing surgery in Department of Orthopedics, Affiliated Hospital of Guangdong Medical University from May 2019 to May 2021 were selected and divided into observation group and control group according to the random number table method, with 50 cases in each group. The control group received traditional continuous iliac fascial space block, and the observation group received continuous iliac fascial space block under multimodal analgesia. The hemodynamic parameters［systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), heart rate(HR)］, the operation-related indicators(operation time, postoperative wake-up time, consciousness recovery time), the cognitive function［Mini-Mental State Examination(MMSE) score］, the analgesic effect［Visual Analogue Scale(VAS) score］, the sedative effect(Ramsay score), and the occurrence of adverse reactions were compared between the two groups. Results There were no significant changes in SBP, DBP, MAP and HR between the two groups at the begin of anesthesia(T1) and before the start of anesthesia(T0) time points, and the differences were not statistically significant(P>0.05). The levels of the various indicators increased at 30-minute time point after anesthesia(T2) and at the end of surgery(T3) time point, but fell back at 12-hour time point after surgery(T4), and they were basically close to the levels at T0 time points. In the observation group, the upward floating trend was small and the recovery was rapid(P<0.05). The postoperative wake-up time and consciousness recovery time of the observation group was shorter than that of the control group(P<0.05). MMSE scores in both groups decreased 24 hours after surgery, while those in the observation group decreased more slightly(P<0.05). The VAS scores and the Ramsay scores showed a downward trend in both groups 2, 12, 24 and 48 hours after surgery, and the VAS scores and the Ramsay scores in the observation group were lower than those in the control group(P<0.05). There was no statistically significant difference in adverse reaction rate between the two groups(P>0.05). Conclusion Continuous iliac fascial space block under multimodal analgesia assisted orthopedic general anesthesia is conducive to stabilizing hemodynamics, improving the effects of sedation and analgesia, promoting postoperative recovery, improving postoperative cognitive function, and has lower adverse reaction rate. |
| Key words: Continuous iliac fascial space block Multimodal analgesia Hemodynamics Cognitive function |
