超聲引導下髖關節囊周神經阻滯對老年髖部骨折病人術后睡眠質量的影響超聲引導下髖關節囊周神經阻滯對老年髖部骨折病人術后睡眠質量的影響

摘要：目的：探究超聲引導下髖關節囊周神經阻滯對老年髖部骨折病人術后睡眠質量的影響。方法：選取2017年1月至2021年6月無錫市中醫醫院收治的老年髖部骨折病人50例，隨機分為觀察組和對照組各25例，兩組均接受正常治療，觀察組在此基礎上加用超聲引導下髖關節囊周神經阻滯治療，對比兩組患者的術后睡眠質量。結果：觀察組患者術后睡眠效果表現更佳，睡眠得分高于對照組（P<0.05），且術后疼痛指數顯著降低（P<0.05）；兩組患者的住院時間、并發癥率和手術效果均無顯著差異（P>0.05）。結論：超聲引導下髖關節囊周神經阻滯治療能有效改善老年髖部骨折術后的睡眠質量，減少術后疼痛，值得在臨床上開展應用。關鍵詞：超聲引導；髖關節囊周神經阻滯；老年；髖部骨折；睡眠質量。

Abstract:Objective:Toexploretheinfluenceofultrasound-guidediliopsoasblockonpostoperativesleepqualityinelderlypatientswithhipfractures.Methods:50elderlypatientswithhipfracturesadmittedtoWuxiTCMHospitalfromJanuary2017toJune2021wererandomlydividedintoobservationgroupandcontrolgroupwith25casesineachgroup.Bothgroupsreceivedroutinetreatment.Intheobservationgroup,ultrasound-guidediliopsoasblockwasaddedonthisbasis.Thepostoperativesleepqualityofthetwogroupswascompared.Results:Thesleepqualityoftheobservationgroupwasbetterthanthatofthecontrolgroup(P<0.05),andthepostoperativepainindexwassignificantlyreduced(P<0.05).Therewasnosignificantdifferenceinhospitalstay,complicationrateandsurgicaleffectbetweenthetwogroups(P>0.05).Conclusion:Ultrasound-guidediliopsoasblockcaneffectivelyimprovepostoperativesleepqualityandreducepostoperativepaininelderlypatientswithhipfractures,whichisworthyofclinicalapplication.Keywords:ultrasound-guided;iliopsoasblock;elderly;hipfracture;sleepqualityHipfracturesareacommoninjuryamongelderlypatients,andtheyoftenrequiresurgicalintervention.Postoperativepainandsleepdisturbancearecommonissuesinthesepatients,whichcannegativelyaffectrecoveryandoverallqualityoflife.Inrecentyears,theuseofultrasound-guidedregionalanesthesiatechniqueshasgainedpopularity,andtheiliopsoasblockhasbeenshowntobeasafeandeffectivemethodforpostoperativepainmanagementinhipfracturepatients.

Inthisstudy,weaimedtoevaluatetheeffectofultrasound-guidediliopsoasblockonsleepqualityandpainmanagementinelderlypatientswithhipfractures.Ourfindingsshowedthatpatientswhoreceivedtheblockhadsignificantlyimprovedsleepqualityandreducedpostoperativepaincomparedtothosewhodidnotreceivetheblock.Furthermore,therewasnosignificantdifferenceinhospitalstay,complicationrate,orsurgicaleffectbetweenthetwogroups.

Themechanismbehindtheanalgesiceffectofiliopsoasblockisbasedonthefactthatthefemoralnerveandtheobturatornerve-bothofwhichprovidesensationtothehipjointandsurroundingtissues-canbeeffectivelyanesthetizedthroughthistechnique.Therefore,byblockingthesenerves,patientsexperiencereducedpainandimprovedsleepquality,whichcancontributetoafasterrecovery.

Ourstudyaddstothegrowingbodyofevidencesupportingtheuseofultrasound-guidedregionalanesthesiatechniquesinelderlypatientswithhipfractures.Giventhehighprevalenceofthisinjuryinthispatientpopulation,itisimportanttoidentifysafeandeffectivemethodsforpainmanagementandrecovery.TheiliopsoasblockisapromisingoptionthatshouldbeconsideredinclinicalpracticeInadditiontothebenefitsofpainreductionandimprovedsleepquality,theuseofultrasound-guidedregionalanesthesiatechniquesinelderlypatientswithhipfracturesmayalsoresultindecreasedopioidconsumptionandshortenedhospitalstays.Thisisparticularlyimportantintheelderlypopulation,whomaybemoresusceptibletoadverseeffectsofopioids,suchasrespiratorydepression,confusion,andfalls.

Theiliopsoasblock,specifically,hasbeenshowntobeasafeandeffectiveoptionforhipfracturepatients.InastudybyNeiraetal.(2015),elderlypatientswhoreceivedanultrasound-guidediliopsoasblockhadsignificantlylowerpainscoresandopioidrequirements,aswellasashorterlengthofhospitalstay,comparedtothosewhoreceivedconventionalpainmanagement.Therewerealsonosignificantadverseeventsrelatedtotheblock.

Otherregionalanesthesiatechniquesthathavebeeninvestigatedinhipfracturepatientsincludethefasciailiacacompartmentblockandlumbarplexusblock.Bothtechniqueshaveshownsimilarbenefitsintermsofpainreduction,decreasedopioidconsumption,andimprovedpatientsatisfaction(Schnabeletal.,2014;Galianoetal.,2018).However,theiliopsoasblockmayofferadvantagesintermsofeaseofperformance,lowerriskofvascularpuncture,andbetterblockadeofpainsensationfromthefemoralneck,whichisthemostcommonsiteofhipfracture.

Itisimportanttonotethatregionalanesthesiatechniquesshouldbeperformedbytrainedandexperiencedpractitioners.Complicationssuchashematoma,infection,nerveinjury,andsystemictoxicity(fromlocalanesthetics)mayoccur,althoughthesearerarewithpropertechniqueandmonitoring.Patientsshouldalsobeinformedoftherisksandbenefitsoftheprocedure,andinformedconsentshouldbeobtained.

Inconclusion,theuseofultrasound-guidedregionalanesthesiatechniques,particularlytheiliopsoasblock,isasafeandeffectiveoptionforpainmanagementinelderlypatientswithhipfractures.Thesetechniquesofferbenefitssuchasdecreasedopioidconsumption,improvedsleepquality,andshortenedhospitalstays,whichcancontributetoafasterrecoveryandbetteroutcomes.HealthcareprovidersshouldconsiderincorporatingregionalanesthesiaintotheirclinicalpracticeforthispatientpopulationInadditiontothebenefitsmentionedabove,ultrasound-guidedregionalanesthesiatechniqueshavealsobeenshowntohavealowerriskofcomplicationscomparedtotraditionalmethodssuchasgeneralanesthesia.Thisisespeciallyimportantforelderlypatientswhomayhaveahigherriskofadverseeffectsfromanesthesia.

Theiliopsoasblockspecificallytargetsthenervesresponsibleforsensationinthehipjoint,makingitaparticularlyeffectiveoptionforpainmanagementinhipfractures.Comparedtootherregionalanesthesiatechniquessuchasthefemoralnerveblockorfasciailiacacompartmentblock,theiliopsoasblockhasalsobeenshowntohavealongerdurationofanalgesia.

OnestudyconductedinSpainfoundthatelderlypatientswhoreceivedanultrasound-guidediliopsoasblockforhipfracturesurgeryhadsignificantlylowerpainscoresandopioidconsumptioncomparedtothosewhoreceivedgeneralanesthesia.Theregionalanesthesiagroupalsohadashorterhospitalstayandweremorelikelytobedischargedtotheirhomesinsteadofarehabilitationcenter.

AnotherstudyinIsraelcomparedtheoutcomesofelderlypatientswhounderwentsurgeryforhipfractureunderregionalanesthesiawiththosewhounderwentsurgeryundergeneralanesthesia.Theregionalanesthesiagrouphadasignificantlylowerrateofdelirium,acommoncomplicationinelderlypatientsfollowingsurgery.Theyalsohadashorterhospitalstayandwerelesslikelytorequireintensivecareunitadmission.

Regionalanesthesiatechniquesmayalsohavepsychologicalbenefitsforelderlypatients.AstudyinFrancefoundthatpatientswhoreceivedafemoralnerveblockforhipfracturesurgeryreportedimprovedmood,lessanxiety,andbetterqualityofsleepcomparedtothosewhoreceivedgeneralanesthesia.Theseimprovementsinpsychosocialwell-beingcanhaveasignificantimpactontheoverallrecoveryandrehabilitationprocess.

Itisimportanttonote,however,thatnotallpatientsaresuitablecandidatesforregionalanesthesia.Factorssuchaspatientpreference,medicalcomorbidities,andsurgicalcontraindicationsshouldbetakenintoconsiderationwhendecidingonthemostappropriateanesthesiatechniqueforeachindividualpatient.

Inconclusion,ultrasound-guidedregionalanesthesiatechniquessuch