超声引导下FICB联合椎管内麻醉对老年股骨头置换术患者术后镇痛及应激反应的影响

doi:10.3969/j.issn.1671-7171.2025.11.027

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摘要 【目的】探讨超声引导下髂筋膜间隙阻滞(FICB)联合椎管内麻醉对老年股骨头置换术患者术后镇痛及应激反应的影响。【方法】60例老年股骨头置换术患者,按照麻醉方法不同分为对照组(n=30,行椎管内麻醉)和观察组(n=34,行超声引导下FICB联合椎管内麻醉)。比较两组术后4 h、8 h、24 h患肢静息时和活动时的疼痛程度[视觉模拟评分法(VAS)评分],镇痛情况,术前、术后24 h的应激反应指标[皮质醇(COR)、肾上腺素(E)、促肾上腺皮质激素(ACTH)]及术后并发症发生情况。【结果】术后4 h、8 h、24 h,两组患者的静息时和活动时VAS评分逐渐降低,且两组不同时间点VAS评分比较,差异均有统计学意义(P<0.05);观察组各时间点VAS评分均低于对照组(P<0.05)。观察组镇痛泵首次按压时间长于对照组(P<0.05),术后24 h内舒芬太尼用量少于对照组(P<0.05),补救镇痛率低于对照组(P<0.05)。术后24 h,两组患者COR、E、ACTH水平均明显高于术前(P<0.05),但观察组COR、E、ACTH水平低于对照组(P<0.05)。观察组并发症总发生率低于对照组(P<0.05)。【结论】FICB联合椎管内麻醉可提高股骨头置换术患者术后镇痛效果,减轻应激反应及降低并发症发生率。

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	王聪丽
	李慧蕴
	王建平

关键词 ：关节成形术,置换,髋, 超声检查, 麻醉,脊椎, 镇痛

Abstract：【Objective】To investigate the effects of ultrasound-guided fascia iliac compartment block (FICB) combined with intraspinal anesthesia on postoperative analgesia and stress response in elderly patients undergoing femoral head replacement. 【Methods】Sixty elderly patients undergoing femoral head replacement were divided according to anesthesia methods into the control group (n=30, receiving intraspinal anesthesia) and the observation group (n=30, receiving ultrasound-guided FICB combined with intraspinal anesthesia). Postoperative pain intensity [visual analogue scale (VAS)] at rest and during movement at 4 h, 8 h, and 24 h, analgesic outcomes, stress response indicators [cortisol (COR), epinephrine (E), and adrenocorticotropic hormone (ACTH)] before surgery and 24 h after surgery, as well as postoperative complications, were compared between the two groups.【Results】At 4 h, 8 h, and 24 h after surgery, VAS scores at rest and during movement decreased gradually in both groups, with statistically significant differences between time points (P<0.05). The VAS scores at all time points were lower in the observation group compared with the control group (P<0.05). The time to first press of the analgesia pump was longer, sufentanil consumption within 24 h was lower, and the rate of rescue analgesia was reduced in the observation group compared with the control group (P<0.05). At 24 h after surgery, COR, E, and ACTH levels were significantly higher than preoperative levels in both groups, but the levels of COR, E, and ACTH in the observation group were lower than those in the control group (P<0.05). The overall incidence of complications in the observation group was also lower than that in the control group (P<0.05).【Conclusion】FICB combined with intraspinal anesthesia can improve postoperative analgesic effects, alleviate stress responses, and reduce the incidence of complications in elderly patients undergoing femoral head replacement.

Key words： Arthroplasty, Replacement, Hip Ultrasonography Anesthesia, Spinal Analgesia

收稿日期: 2024-11-18

中图分类号:

R683.42

引用本文:

王聪丽, 李慧蕴, 王建平. 超声引导下FICB联合椎管内麻醉对老年股骨头置换术患者术后镇痛及应激反应的影响[J]. 医学临床研究, 2025, 42(11): 1937-1940.
WANG Congli, LI Huiyun, WANG Jianping. Effects of Ultrasound-Guided Fascia Iliac Compartment Block Combined with Intraspinal Anesthesia on Postoperative Analgesia and Stress Response in Elderly Patients Undergoing Femoral Head Replacement. JOURNAL OF CLINICAL RESEARCH, 2025, 42(11): 1937-1940.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2025.11.027 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2025/V42/I11/1937

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