中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (8): 1149-1154.doi: 10.3969/j.issn.2095-4344.1070

• 人工假体 artificial prosthesis •    下一篇

超声引导下仰卧位腰丛阻滞与髂筋膜阻滞对高龄患者髋关节置换镇痛的比较：单中心、随机、对照临床试验

陆小龙1，俞学锋1，胡四毛1，郑学磊1，李 琼1，刘 勇1，王盘如1，彭建敏1，梅 斌2   

  1. 1六安世立医院麻醉科，安徽省六安市  237000；2安徽医科大学第一附属医院麻醉科，安徽省合肥市  230022
  • 出版日期:2019-03-18 发布日期:2019-03-18
  • 通讯作者: 陆小龙，六安世立医院麻醉科，安徽省六安市 237000
  • 作者简介:陆小龙，硕士，主治医师。
  • 基金资助:

    六安世立医院青年基金培育计划，项目负责人：陆小龙

Ultrasound-guided lumbar plexus block in supine position versus iliac fascia block for analgesia in elderly patients undergoing hip replacement: a single-center, randomized, controlled clinical trial

Lu Xiaolong1, Yu Xuefeng1, Hu Simao1, Zheng Xuelei1, Li Qiong1, Liu Yong1, Wang Panru1, Peng Jianmin1, Mei Bin2   

  1. 1Department of Anesthesiology, Lu’an Civily Hospital, Lu’an 237000, Anhui Province, China; 2Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
  • Online:2019-03-18 Published:2019-03-18
  • Contact: Lu Xiaolong, Department of Anesthesiology, Lu’an Civily Hospital, Lu’an 237000, Anhui Province, China
  • About author:Lu Xiaolong, Master, Attending physician, Department of Anesthesiology, Lu’an Civily Hospital, Lu’an 237000, Anhui Province, China
  • Supported by:

    the Young Talent Training Program of Lu’an Civily Hospital (to LXL)

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摘要：

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文题释义：
腰丛神经：主要由股神经、闭孔神经和股外侧皮神经构成，支配大腿外侧、前方和内侧的感觉。
超声引导下的腰丛神经阻滞：腰丛神经位置较深，按常规方法阻滞效果并不明确，而通过超声定位可直视神经位置、局麻药物扩散以及周围脏器情况，从而阻滞了支配髋部的大部分神经。
 
摘要
背景：高龄患者接受髋关节置换，手术的麻醉是很重要的环节。腰丛以及髂筋膜阻滞都是髋关节置换常用的麻醉阻滞方法。
目的：试验拟观察超声引导下仰卧位腰丛阻滞与多角度多点髂筋膜阻滞在高龄髋关节置换患者围术期镇痛效果，以筛选出对此类患者的最佳镇痛方案。
方法：研究为前瞻性、单中心、随机、对照临床试验。拟收集中国安徽省六安世立医院的高龄髋关节置换住院患者208例，随机分为2组，每组104例，腰丛组行仰卧位腰丛神经阻滞后联合喉罩全身麻醉，髂筋膜组行多角度多点髂筋膜神经阻滞后联合喉罩全身麻醉，麻醉后两组进行髋关节置换。术后随访24 h。试验经六安世立医院医学伦理委员会批准(批准号：PJ2018-001，审批时间：2018年3月)，方案版本号1.0。参与试验的患者在充分了解治疗方案的前提下签署“知情同意书”。
结果与结论：研究的主要结局指标为术后24 h以目测类比评分法评估术后镇痛效果；次要观察指标为术后2，6，12 h的目测类比评分变化，术中各时间点[喉罩置入时(T0)、手术切皮时(T1)、手术扩髓时(T2)、假体植入时(T3)、缝切口时(T4)、入复苏室后(T5)]心率、平均动脉压和血氧饱和度变化，术中舒芬太尼、佩尔地平、麻黄碱用量，术后2，6，12，24 h静脉自控镇痛用药总量及不良反应发生率。课题组前期(2018年3月至9月)已完成了60例高龄髋关节置换患者的小样本试验结果，腰丛组30例术中舒芬太尼、佩尔地平及麻黄碱的用量明显低于髂筋膜组(P < 0.05)；髂筋膜组30例T2至T5时的心率与腰丛组相应时间点相比明显升高(P < 0.05)，且在T1，T2，T3，T5时心率大于同组T0 (P < 0.05)；同时髂筋膜组T1至T5时的平均动脉压高于腰丛组(P < 0.05)，在T1至T4时的平均动脉压高于同组T0 (P < 0.05)；而腰丛组T3，T4时的平均动脉压略低于同组T0 (P < 0.05)。腰丛组术后6，12，24 h疼痛目测类比评分低于髂筋膜组(P < 0.05)。试验期望证实，与多角度多点髂筋膜阻滞相比，超声引导下仰卧位腰丛神经阻滞联合全身麻醉可以有效的维持髋关节置换过程中血流动力学指标的稳定性，为高龄髋关节置换者提供良好的术后镇痛效果。试验已在中国临床试验注册中心注册(注册号：ChiCTR1800019888)，注册时间：2018年12月7日。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-6837-5410(陆小龙)

关键词: 超声引导, 腰丛神经阻滞, 髂筋膜神经阻滞, 髋关节置换, 高龄髋关节置换, 关节置换麻醉, 术后镇痛

Abstract:

BACKGROUND: Anesthesia is an important part of hip replacement in older adult patients. Lumbar plexus block and iliac fascia block are common block methods in hip replacement.

OBJECTIVE: To investigate the analgesic effect of ultrasound-guided lumbar plexus block in supine position versus multi-angle multi-point iliac fascia block during hip replacement in older adult patients to screen the optimal analgesic regimen.
METHODS: This prospective, single-center, randomized, controlled trial will include 208 older adult patients scheduled to undergo hip replacement from wards of Lu’an Civily Hospital in China. These patients will be randomly assigned to two groups (n = 104/group). In the lumbar plexus block group, patients will undergo lumbar plexus block in supine position, general anesthesia using a laryngeal mask airway and later hip replacement. In the iliac fascia block group, patients will undergo multi-angle multi-point iliac fascia block, general anesthesia using a laryngeal mask airway and later hip replacement. After surgery, all patients will be followed up for 24 hours. This study was approved by Medical Ethics Committee of Lu’an Civily Hospital in China in March 2018 (approval No. PJ2018-001). The study protocol is 1.0. Patients participating in this study will sign informed consent after fully understanding the study protocol.
RESULTS AND CONCLUSION: The primary outcome measure of this study is Visual Analog Scale score at 24 hours post-surgery, which is used to evaluate postoperative analgesic effect. The secondary outcome measures of this study are Visual Analog Scale score at 2, 6 and 12 hours post-surgery, heart rate at various time points during the surgery [laryngeal mask placement (T0), surgical incision (T1), surgical reaming (T2), prosthesis implantation (T3), incision suture (T4), and resuscitation (T5)], mean arterial pressure, blood oxygen saturation, intraoperative sufentanil, perdipine, and ephedrine dosages, total amount of intravenous patient controlled analgesics at 2, 6, 12, and 24 hours post-surgery, and incidence of adverse reactions. Results of a pilot study involving 60 older adult patients who underwent hip replacement from March to September 2018 showed that intraoperative sufentanil, perdipine, and ephedrine dosages were significantly lower in the lumbar plexus block group (n=30) than in the iliac fascia block group (n=30; P < 0.05); heart rate at T2, T3, T4 and T5 was significantly lower in the lumbar plexus block group than in the iliac fascia block group (P < 0.05); heart rate at T1, T2, T3, T5 was significantly greater than that at T0 in the iliac fascia block group (P < 0.05); mean arterial pressure at T1, T2, T3, T4 and T5 was significantly lower in the lumbar plexus block group than that in the iliac fascia block group (P < 0.05), and mean arterial pressure at T1, T2, T3 and T4 was significantly higher than that at T0 in the iliac fascia block group (P < 0.05). Mean arterial pressure at T3 and T4 was significantly lower than that at T0 in the lumbar plexus block group (P < 0.05). Visual Analogue Scale score at 6, 12 and 24 hours post-surgery was significantly higher in the iliac fascia block group than in the lumbar plexus block group (P < 0.05). Results from this study will provide evidence indicating whether ultrasound-guided lumbar plexus block in supine position in combination with general anesthesia can more effectively maintain stable hemodynamic index during hip replacement and exhibits more encouraging postoperative analgesic effects in older adult patients than multi-angle multi-point iliac fascia block. This trial had been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800019888) on December 7, 2018. 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tissue Engineering, Arthroplasty, Replacement, Hip, Sufentanil

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