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超声引导下神经阻滞用于髋关节置换术患者术后镇痛的研究进展
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Abstract:
近年来，由于人口老龄化和预期寿命的增加，髋部骨折的发生率逐年增加。预计到2050年，整个亚洲的髋部骨折患者将增加至2500多万例。髋关节置换术(total hip arthroplasty, THA)作为髋部骨折的主要治疗方法之一，能够有效恢复患者的生活质量和功能状态，但随之而来的术后镇痛难题也越来越引起临床麻醉医师的关注。充分的术后镇痛对提高患者满意度及早期康复至关重要，也符合加速康复外科(ERAS)的基本理念。就现阶段而言，患者自控静脉镇痛(PCIA)是临床上髋关节置换术后常用的镇痛方案，但极易导致许多与阿片类药物相关的副作用，例如恶心、呕吐和便秘等胃肠道反应，甚至出现呼吸抑制、心血管意外和药物依赖等。周围神经阻滞可以减少阿片类药物的使用量，极大程度地降低阿片类药物相关并发症的发生率，在术后镇痛方面优势愈发突显。与此同时，随着超声技术的不断发展，超声引导下神经阻滞逐渐成为临床麻醉的主流方式。本文就超声引导下神经阻滞在髋关节置换术患者术后镇痛中的研究进展进行综述。
In recent years, the incidence of hip fractures has been increasing every year due to an aging population and increased life expectancy. It is expected that by 2050, the number of hip fracture patients across Asia will increase to more than 25 million cases. As one of the main treatments for hip fracture, total hip arthroplasty (THA) can effectively restore patients’ quality of life and functional status, but the ensuing difficulty of postoperative analgesia has attracted more and more attention from clinical anesthesiologists. Adequate postoperative analgesia is essential to improve patient satisfaction and early recovery, and is also in line with the basic concept of accelerated rehabilitation surgery (ERAS). At this stage, patient-controlled intravenous analgesia (PCIA) is a commonly used analgesic regimen after hip arthroplasty, but it is prone to many opioid-related side effects, such as gastrointestinal reactions like nausea, vomiting and constipation, and even respiratory depression, cardiovascular accidents and drug dependence. Peripheral nerve block can reduce the use of opioids, greatly reduce the incidence of opioid-related complications, and the advantages of postoperative analgesia are becoming more and more prominent. Meanwhile, with the continuous development of ultrasound technology, ultrasound-guided nerve block has gradually become the mainstream of clinical anesthesia. This article summarizes the research progress of ultrasound-guided nerve block in postoperative analgesia of hip arthroplasty patients.
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