超声引导下不同入路FICB在老年THA改成中文中的镇痛效果研究删除.docx

超声引导下不同入路FlCB在老年THAI中的镇痛效果胱究I李彦平，方圆，张旭，马玉林，石利*安康市中心医院麻醉科陕西安康725000第一作者：李彦平(1980年08月)，男，学士，副主任医师，研究方向：主要从事临床麻醉及疼痛，邮箱：通讯作者：石磊(1987年12月)，男，学士，副主任医师，研究方向：主要从事麻醉科临床手术麻醉,及门诊疼痛科工作，邮箱：批注A1：改成中文批注【A2)：删除课题基金：陕西省科学技术研窕发展计划项目2016SF-248摘要旧的：I研究超声引导下不同入路骼筋膜间隙阻滞(FlCB)在老年酸关节置换术(THA)一一'批注A3)：观察中的镇痛效果。方法,选取本院2021年10月-2022年10月收治的80例行THA的老年患者的人研究按照随机数字表法I将患者!分为A组和B,各依例。A组采用超声引导下内侧一入路FICB,B组采用超声引导下外侧入路FICB。观察并比较两组患者手术时间、术中出血量、复苏室停留时间、术后拔管时间、术后48h视觉疼痛模拟(VAS)评分、舒芬太尼使用量、术后拔管时间、住院时间等I围术期储标，探刺注药时间、置管时间、导管重新固定例数、置管深度等术后相关阻滞指标，恤清P物质(SP)、神经肽Y(NPY)、前列腺素E2(PGEz)、5-羟色胺(5-HT)等疼痛介质招标，血清去甲肾上腺素(NE)、皮质醇(Cor)水平、C反、应蛋白(CRP)等应激反应指标以及不良反应发生情况。踣果两组患者的手术时间、豆苏室停留时间、术后拔管时间、术中出血量、舒芬太尼使用量、第一次下床活动时间以及住院时间比较，差异无统计学意义(PX).()5)；A组术后48h的VAS评分为(2.43±0.45)分，显著低于B组的(3.48±0,52)分，差异有统计学意义(Pv005)。两组患者穿刺注药时间比较，差异无统计学意义(P>0.05);A组导管重新固定例数比例为5.00%,明显少于B组的25.00%,置管时间为(63.29±8.36)s,明显短于B组的(155.4O±9.25)min,置管深度为(I1.13±L27)cm,明显长于B组的(7.09±1.18)cm,差异具有统计学意义(PeO.05)。术前，两组患者NE、CRP,COr水平比较，差异无统计学意义(PX).05)；术后Id,A组NE、CRP、COr水平分别为(23616±16.33)pg/mL、(7.18±0.64)mg/Lx(193.62±24.19)pgmL,均明显低于B组的(289.29±27.12)pgmL.(12.40±l.41)mg/L、(235.39±26.31)pgmL,差异有统计学意义(P<0.05)o术前，两组患者NPY、SP、PGE2、5-HT水平比我，不并无统计学意义(PX).05):术后ld,A组NPY、SP、PGE2、5-羟色胺(5-HT)水平分别为(68.68±7.5I)pgmL'(72.14±8.38)pgmL.(28.99±5.32)ngmL,(0.64±0.14)molL,均明显低于B组的(8L29±8.45)pgmL'(95.68±9.35)pg/mL、(3948±4.80)ng/mL、(0.95±0.22)molL,差异有统计学意义(P<005)。术后，A组不良反应发生率为0.00%,B组不良反应发生率为5.00%,两组比较差异无统计学意义(P>005)。结论：超声引导下内侧入路和外侧入路批注【A5):删除批注A4：删除批注A6:.每组批注(A7J:耽除批注A8):修改.使语句通顺批注(A9:使通顺FICB在老年THA中均具有较好的镇痛效果，但图声引导Tl内侧入路段外侧入路在减轻应激一批注Al。：删除反应、疼痛刺激等方面更具有优势。【关穗词】全脆关节置换术；潞筋膜间隙阻滞；超声：内侧入路；外侧入路：镇痛效果StudyontheanalgesiceffectofultrasoundguidedFICBwithdifferentapproachesinelderlypatientswithTHALiYanpingFangYuanZhangXuMaYulinShiLei*AnkangCityCentralHospitaldepartmentofanesthesiologyShaanxiankang725000AbstractObjcctivcjTostudyontheanalgesiceffectofultrasound-guidedfasciailiacacompartmentblock(FICB)withdifferentapproachesinelderlypatientswithtotalhiparthroplasty(THA).Methods:80elderlypatientswithTHadmittedtoourhospitalfromOctober2021toOctober2022wereincludedinthestudy.Accordingtotherandomnumbertablemethod,thepatientsweredividedintogroupAandgroupBwith40caseseach.GroupAwastreatedwithultrasound-guidedinternalapproachFICB,whilegroupBwastreatedwithultrasound-guidedexternalapproachFICB.Theperioperativeindexessuchasoperationtime,intraoperativebleedingvolume,residencetimeintheresuscitationrm.extubationtimeafteroperation,visualpainsimulation(VAS)scoreat48hafteroperation,sufentanilusevolume,extubationtimeafteroperation,hospitalizationtime,thepostoperativerelatedblockingindicatorssuchaspunctureinjectiontime,catheterinsertiontime,numberofcatheterre-fixationcases,catheterinsertiondepth,theserumpainmediatorssuchasserumsubstanceP(SP),neuropeptideY(NPY),prostaglandinE2(PGE2),5-hydroxytryptamine(5-HT),stressresponseindicatorssuchasserumnorepinephrine(NE),cortisol(Cor)andC-reactiveprotein(CRP).andadversereactionswereobservedandcompared.Results:Therewasnosignificantdifferencebetweenthetwogroupsinoperationtime,staytimeintheresuscitationroom,extubationtimeafteroperation,intraoperativebleeding,useofsufentanil,Iimeoffirstambulationandhospitalizationtime(P>0.05);TheVASscoreofg>upAat48hoursafteroperationwas(2.43±().45),whichwassignicantlylowerthanthatofgroupB(3.48±O.52),andstatisticallysignicant(P<0.05).Therewasnosignicantdifferencebetweenthetwogroups(P>0.05):Thenumberofcasesofcatheterre-fixationingroupAwas5.00%,significantlylessthan25.00%ingroupB,thetimeofcatheterPIaCementwas(63.29±8.36)s,significantlyshorterthanthatingroupB(155.4O±9.25)min,thedepthofcatheterplacementwas(11.13±I.27)cm,significantlylongerthanthatingroupB(7.09±1.18)cm,andstatisticallysignificant(P<0.05).TherewasnosignificantdifferenceinNE,CRPandCorlevelsbetweenthetwogroupsbeforeoperation(P>0.05):1dayafteroperation,thelevelsofNE.CRPandCoringroupAwere(236.16±I6.33)pgmL,(7.18±().64)pg/Land(193.62±24.I9)pgmL,whichweresignicantlylowerthanthoseingroupB(289.29±27.12)pgmL,(12.40±1.41)pg/Land(235.39±26.31)pgmL.andstatisticallysignificant(P<0.05).Beforeoperation,therewasnosignificantdifferenceinthelevelsofNPY,SP,PGE2and5-HTbetweenthetwogroups(P>0.05);Idayafteroperation,thelevelsofNPY.SP,PGE2and5-HTingroupAwere(68.68±7.51)pgmL,(72.14±8.38)pgmL,(28.99±532)ngmL,(0.64±0.14)MolL,significantlylowerthanthatofgroupB(81.29±8.45)pgmL,(95.68±9.35)pgmL,(39.48±4.80)ngmL,(0.95±0.22)MolL,andstatisticallysignicant(P<0.05).Afteroperation,theincidenceofadversereactionsinGroupAwas0.(X)%(0/40),andthatinGroupBwas5.(X)%(2/40),therewasnoSignifiCanldificrenccbetweenthetwogroups(P>0.05).Conclusion:Boththeultrasound-guidedmedialapproachandthelateralapproachFICBhavebetteranalgesiceffectinelderlypatientswithTHA.buttheullrasund-guidcdmedialapproachhasmoreadvantagesthanthelateralapproachinreducingstressresponseandpainstimulation.Keywords：Totalhipreplacement;iliacfasciaspaceblock;ult