髂筋膜腔隙阻滞在老年股骨颈骨折患者腰硬联合麻醉前摆放体位时的应用研究

目的观察髂筋膜腔隙阻滞在老年股骨颈骨折患者腰硬联合麻醉前摆放体位时的镇痛作用。方法将50例老年患者按随机数字表法分成两组，其中观察组为髂筋膜腔隙阻滞（FIC）组25例，对照组为静脉镇痛（IVA）组25例。FIC组在腰硬联合麻醉20min前予0.375%盐酸罗哌卡因行髂筋膜腔隙阻滞，IVA组在腰硬联合麻醉2min前予以1滋g/kg枸橼酸芬太尼注射。观察两组患者入手术室后、摆放体位时、术后6、24、48h的VAS疼痛评分；腰硬联合麻醉操作时间；围术期芬太尼总耗量；患者对操作前干预手段的接受度和不良事件发生率等指标。结果 FIC组比IVA组在摆放体位时和术后6h的VAS疼痛评分降低，分别为2.4±0.9、4.1±1.1及2.2±0.5、3.5±0.8（均P＜0.01）；腰硬联合麻醉操作时间缩短，分别为8.1±2.9、12.9±5.1（P＜0.01）；术后恶心、呕吐发生率下降，分别为10％、23％（P＜0.01）；患者接受度提高，分别为23/25、11/25（P＜0.01）；芬太尼用量增加，分别为（460＋88）、（550＋126）滋g（P＜0.01）。结论相比静脉芬太尼镇痛，超声引导下髂筋膜腔隙阻滞提供了更好的镇痛和更少的麻醉并发症。     

A comparison of HIFU-induced lesion size measurement based on gross histological examination and image of bovine thigh in vitro

The aim of this study was to investigate the agreement in HIFU-induced lesion sizes between measurements based on gross histological examination and those from images. Experiments were conducted in an experimental arrangement with a three-way multiscan ultrasonic inspection system and imaging was done by B-mode ultrasound (US). Bovine thigh muscle with and without fascia lata was treated with an in situ spatially averaged focal intensity ranging between 750 W cm(-2) and 1565 W cm(-2) and sonication-time was variable from 8 to 20s. Assessment of the two measurement methods showed a rather weak correlation in the samples without fascia lata. For clarity and convenience in the discussion, sample muscles with and without fascia lata were labeled F and M, respectively. It was difficult to measure the lesion size from ultrasonographic images of F samples, so there was disagreement in the samples with fascia lata. This investigation showed that the presence of fascia lata in bovine thigh muscle has the likely effect of affecting the ultrasound image and makes it difficult to distinguish coagulated tissue from surrounding healthy tissue. There was no significant correlation between ultrasonography and the gross histological findings in M samples. Data supported that at for an in situ spatially averaged focal intensity ranging between 750 W cm(-2) and 1565 W cm(-2) and relatively shorter exposures (sonication-time variable from 1 to 8s) higher correlation between image and gross histology measurement was found in excised bovine muscle specimens.