摘要
目的 髂腰肌间隙连续前路腰丛阻滞用于老年髋部骨折术前镇痛，以期达到有效的镇痛，减轻患者应激反应。方法 以老年髋部骨折患者为研究对象，选择2022年11月-2024年11月骨科患者60例，使用随机数表法分为观察组和对照组两组，每组30人。观察组（A组）在髂腰肌间隙连续使用罗哌卡因阻滞前路腰丛镇痛，对照组（B组）不采用神经阻滞镇痛，两组病人均按需给予曲马多缓释片镇痛。观察患者疼痛评分、镇痛药使用量、应激反应、不良反应及并发症。结果 与B组相比较，A组的VAS（视觉模拟评分法）评分更低（镇痛30min、镇痛4h、镇痛12h，P＜0.001；镇痛24h，P= 0.006）。镇痛药使用量更少、应激反应更小，差异具有统计学意义（P＜0.05）。结论 髂腰肌间隙连续前路腰丛阻滞镇痛效果显著，可用于老年髋部骨折术前镇痛，并减轻患者应激反应。
关键词： 髂腰肌间隙；连续腰丛阻滞；前路腰丛阻滞；老年髋部骨折；术前镇痛
Abstract
Objective Continuous anterior lumbar plexus block in the iliopsoas space is used for preoperative analgesia in elderly patients with hip fractures, in order to achieve effective analgesia and reduce the stress response of patients. Methods A total of 60 orthopedic patients from November 2022 to November 2024 were selected as the research subjects, all of whom were elderly patients with hip fractures. They were randomly divided into an observation group and a control group using the random number table method, with 30 patients in each group. Observation group (group A) continued to use ropivacaine to block anterior lumbar plexus analgesia in the iliopsoas space, control group (group B) did not use nerve block analgesia, both groups were given tramadol sustained release tablet analgesia as needed. Pain score, analgesic dosage, stress response, adverse reactions and complications were observed. Results Compared with group B, group A had lower VAS (visual analogue scale) score (analgesia at 30 min, 4 h, and 12 h, P < 0.001; analgesia at 24 h, P = 0.006.), less analgesic drug use and less stress reaction, and the discrepancy have statistical significance (P < 0.05). Conclusion The effect of continuous anterior lumbar plexus block between iliopsoas muscle space is significant, which can be used for preoperative analgesia in elderly patients with hip fractures and reduce the stress response.
Key words： Iliopsoas space; Continuous lumbar plexus block; Anterior lumbar plexus block; Elderly hip fracture; Preoperative analgesia
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