超声引导内侧与外侧入路持续髂筋膜间隙阻滞在全髋关节置换术中应用效果的对比研究

摘要 目的：对比持续髂筋膜间隙阻滞（FICB）采用超声引导内侧或外侧入路在全髋关节置换术（THA）中应用效果。方法：选择2019年6月～2021年6月期间在我院接受治疗的THA患者97例作为研究对象。根据随机数字表法将患者分为外侧组和内侧组，例数分别为48例和49例。对比两组围术期指标，术后阻滞相关指标、疼痛介质、应激反应指标和不良反应。结果：两组术中出血量、舒芬太尼使用量、术后拔管/手术/住院/第一次下床活动、复苏室停留等状态时间组间对比无差异（P>0.05），内侧组术后48h 视觉疼痛模拟（VAS）评分小于外侧组（P<0.05）。两组穿刺注药时间对比无明显差异（P>0.05），内侧组置管时间短于外侧组，导管重新固定例数少于外侧组，置管深度长于外侧组（P<0.05）。两组术后24h的 P物质（SP）、前列腺素E₂（PGE₂）、神经肽Y（NPY）、5-羟色胺（5-HT）均升高，但内侧组低于外侧组（P<0.05）。两组术后24h皮质醇（Cor）、C反应蛋白（CRP）、去甲肾上腺素（NE）均升高，但内侧组低于外侧组（P<0.05）。外侧组、内侧组的不良反应发生率组间比较无差异（P>0.05）。结论：经超声引导内侧与外侧入路FICB均可为THA患者提供良好的镇痛阻滞，促进患者术后恢复，内侧入路在减轻疼痛刺激、应激反应、置管操作等方面更具优势。

Comparative Study on the Application Effect of Ultrasound-Guided Medial and Lateral Approach Continuous Iliac Fascial Space Block in Total Hip Arthroplasty

ABSTRACT Objective: To compare the application effect of ultrasound-guided medial and lateral approach continuous fascia iliaca compartment block (FICB) in total hip arthroplasty (THA). Methods: 97 THA patients who were treated in our hospital from June 2019 to June 2021 were selected as the research objects. According to the random number table method, the patients were divided into lateral group and medial group, with 48 cases and 49 cases respectively. The perioperative indexes, postoperative block related indexes, pain mediators, stress response indexes and adverse reactions were compared between the two groups. Results: There were no differences between the two groups in the amount of intraoperative bleeding, the sufentanil usage, the time of extubation/operation/hospitalization/ first out of bed activity and stay in the resuscitation room (P>0.05). The visual analogue scale (VAS) score at 48h after operation in the medial group was lower than that in the lateral group (P<0.05). There was no significant difference in the time of puncture and drug injection between the two groups (P>0.05). The time of catheter placement in the medial group was shorter than that in the lateral group, the number of cases of catheter re fixation was less than that in the lateral group, and the depth of catheter placement was longer than that in the lateral group (P<0.05). The substance P (SP), prostaglandin E₂ (PGE₂), neuropeptide Y (NPY) and 5-hydroxytryptamine (5-HT) increased at 24 h after operation in the two groups, but the medial group was lower than the lateral group (P<0.05). Cortisol (Cor), C-reactive protein (CRP) and norepinephrine (NE) increased at 24 h after operation in the two groups, but the medial group was lower than the lateral group (P<0.05). There was no difference in the incidence of adverse reactions between the lateral group and the medial group (P>0.05). Conclusion: The ultrasound-guided medial and lateral approach FICB can provide good analgesic block for THA patients, and promote their postoperative recovery. The medial approach has more advantages in alleviating pain stimulation, stress response and catheter operation.