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Received:December 03, 2020 Published Online:June 20, 2021
Received:December 03, 2020 Published Online:June 20, 2021
中文摘要: 目的 探究超声引导下髂筋膜间隙多点阻滞对高龄下肢手术患者神经阻滞成功率、免疫抑制及术后早期康复锻炼耐受性的影响。方法 选取苏州大学附属无锡九院2019年1月至12月高龄下肢手术患者128例作为研究对象,按照随机数字表法为观察组和对照组,各64例。对照组采取超声引导下髂筋膜间隙单次阻滞,观察组采取超声引导下髂筋膜间隙多点阻滞。比较两组股神经、股外侧皮神经、闭孔神经感觉阻滞起效时间和给药30 min后阻滞成功率，术前及术后6、12、24、48 h静态与动态疼痛视觉模拟量表(VAS)评分、免疫抑制情况(CD3+、CD4+、CD8+、NK)细胞水平、机体应激指标［血糖(Glu)、血清皮质醇(Cor)、白细胞介素-6(IL-6)］水平，以及术后早期康复锻炼耐受性和不良反应发生情况。结果 观察组股外侧皮神经、闭孔神经感觉阻滞起效时间短于对照组(P<0.01);观察组股外侧皮神经、闭孔神经阻滞成功率高于对照组(P<0.05);观察组术后6、12、24、48 h静态与动态VAS评分以及血清Cor、IL-6、Glu水平低于对照组(P<0.05);观察组术后12、24、48 h CD3+、CD4+、NK细胞高于对照组,CD8+低于对照组(P<0.01);观察组术后早期康复锻炼耐受性优于对照组(P<0.01);观察组不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论 超声引导下髂筋膜间隙多点阻滞应用于高龄下肢手术患者,能有效缩短股外侧皮神经、闭孔神经感觉阻滞起效时间,提高股外侧皮神经、闭孔神经阻滞成功率,降低疼痛程度,减轻免疫抑制及机体应激,增强康复锻炼耐受性,且安全性高。
Abstract:Objective To explore the influences of ultrasound-guided multi-point fascia iliaca compartment block(FICB) on the success rate of nerve block,immunosuppression and early postoperative rehabilitation exercise tolerance in elderly patients with lower extremity surgery. Methods A total of 128 elderly patients received lower extremity surgery from January to December 2019 were selected as the research objects and were randomly divided into observation group and control group (n=64,each).The ultrasound-guided single-point FICB was performed in control group,and the ultrasound-guided multi-point FICB was conducted in observation group. The onset time of sensory block of femoral nerve,lateral femoral cutaneous nerve and obturator nerve,and the success rate of block after 30 minutes of administration were compraed between two groups.The static and dynamic pain visual analogue scale (VAS),the status of immunosuppression(levels of CD3+,CD4+,CD8+ and NK cells),the body stress index levels［blood glucose (Glu),serum cortisol (Cor),interleukin-6 (IL-6)］ before and 6-,12-,24-,48-h after operation，as well as postoperative early rehabilitation exercise tolerance and adverse reactions were compared between two groups.
Results The onset time of sensory block of lateral femoral cutaneous nerve and obturator nerve in observation group was significantly shorter than that in control group (P<0.01),and the success rate of block in observation group was higher than that in control group (P<0.05).Compared with control group,the static and dynamic VAS scores and serum levels of Cor,Glu and IL-6 decreased at 6-,12-,24- and 48-h in observation group(P<0.05,P<0.01).At 12-,24- and 48-h after surgery,CD3+ and CD4+cells and NK cells in observation group were higher than those in control group,and CD8+ was lower than that in control group (all P<0.01).The early postoperative rehabilitation exercise tolerance in observation group was superior to that in control group (P<0.05).There was no significant difference in the incidence of adverse reactions between two groups (P>0.05). Conclusion In elderly patients with lower extremity surgery,ultrasound-guided multi-point FICB can effectively shorten the onset time of sensory block of lateral femoral cutaneous nerve and obturator nerve,increase the success rate of block,reduce the degree of pain,improve stress-induced immunosuppression and enhance exercise tolerance with high safety.
keywords: Ultrasound guidance Multi-point fascia iliaca compartment block Elderly Lower extremity surgery Success rate of nerve
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