超声引导下髂筋膜间隙阻滞在小儿股骨骨折术后的镇痛效果

Analgesic Effect of Ultrasound-Guided Fascia Iliac Compartment Block after Pediatric Femoral Fracture

摘要: 目的：探讨超声引导下髂筋膜间隙阻滞(Fascia iliaca compartment block, FICB)对小儿股骨骨折术后镇痛效果的影响。方法：选取2017年5月~2018年6月期间在本院就诊的51例小儿股骨骨折临床资料进行回顾性分析，根据麻醉方式不同分为髂筋膜间隙阻滞组(FI组，n = 24)和静脉芬太尼组(FE组，n = 227)。全麻诱导后，两组均进行超声引导下髂筋膜间隙穿刺，FI组给予罗哌卡因，FE组给予等量生理盐水，术后FI组给予罗哌卡因自控镇痛(Patient controlled analgesia, PCA)，FE组给予芬太尼PCA。比较两组术后即刻、术后6 h、术后12 h患儿疼痛程度，患儿镇静程度，术后0 h~6 h、7 h~12 h两个时间段PCA给药次数，并发症发生情况。结果：FI组3~7岁患儿术后不同时间点疼痛行为量表(Legs Activity Cry Consolability, FLACC)评分均低于FE组，差异有统计学意义(P < 0.05)；FI组8~14岁患儿术后不同时间点视觉模拟评分量表(Visual Analogue Scale, VAS)评分均低于FE组，差异有统计学意义(P < 0.05)；FI组患儿术后不同时间点 Ramsay评分均低于对照组，但差异无统计学意义(P > 0.05)；术后不同时间段，FI组PCA给药次数均少于FE组，差异有统计学意义(P < 0.05)；FI组并发症发生情况少于FE组，但差异无统计学意义(P > 0.05)。结论：超声引导下FICB应用于小儿股骨骨折术后镇痛效果显著优于静脉芬太尼麻醉，值得临床推广。

Abstract: Objective: To investigate the effect of ultrasound-guided Fascia iliaca compartment block (FICB) on postoperative analgesia in children with femoral fractures. Methods: The clinical data of 51 children with femoral fractures from May 2017 to June 2018 were retrospectively analyzed. The patients were divided into the fascia iliac compartment block group (FI group, n = 24) and intravenous fentanyl group (FE group, n = 27) according to the anesthesia method. After induction of general anesthesia, both groups underwent ultrasound-guided iliac fascia puncture. The FI group was given ropivacaine, and the FE group was given the same amount of normal saline; after the surgery, the FI group was given ropivacaine-controlled analgesia (Patient controlled analgesia, PCA), and the FE group was given fentanyl PCA. The degree of pain in the children immediately after surgery, 6 hours after surgery, 12 hours after surgery, the degree of sedation in the children, the number of PCA administrations in the two periods of 0 to 6 h, 7 to 12 h after operation, and the complications were compared between the two groups. Results: The scores of Legs Activity Cry Consolability (FLACC) in the 3 to 7 years old children at different time points in the FI group were lower than those in the FE group (P < 0.05). The visual analogue scale (Visual Analogue Scale, VAS) scores in 8 to 14 years old children at different time points of the FI group were lower than those of the FE group (P < 0.05). The children in the FI group had lower Ramsay scores at different time points after operation than the control group (P > 0.05). After the surgery, the number of PCA administration at different time points in the FI group was less than that in the FE group (P < 0.05); the complications occurring in the FI group was less than that in the FE group (P > 0.05). Conclusion: Ultrasound-guided FICB is superior to intravenous fentanyl anesthesia in the treatment of femoral fractures in children. It is worthy of clinical promotion.