ObjectiveTo describe and evaluate the clinical studies of postoperative pain sensitization caused by sleep deprivation through the evidence map system, understand the distribution of evidence in this field, and provide reference for subsequent evidence research.MethodsA computer-based search of PubMed, EMBASE, Cochrane library, Web of Science, CNKI, Wanfang Data, VIP and Chinese Biomedical Literature Database from inception to August 2023 was conducted to obtain intervention studies, observational studies and systematic reviews/Meta-analysis of postoperative pain sensitization caused by sleep deprivation. The research characteristics and methodological quality were analyzed and evaluated. The Cochrane Handbook for Systematic Reviews, the Newcastle-Ottawa Scale (NOS) and the AMSTAR-2 scale were used to evaluate the quality of the included studies, and the evidence was comprehensively analyzed and displayed by means of bubble chart, table and text.ResultsA total of 35 observational studies (31 cohort studies and 4 case-control studies), 15 randomized controlled trials and 4 systematic reviews/Meta-analyses were included. The number of publications increased rapidly after 2018 and peaked in 2022, and clinical studies in this field mainly focused on cohort studies, with fewer randomized controlled trials and systematic reviews/Meta-analysis studies. The results of the evidence map showed that in terms of quality, 22 studies were 'high quality', 24 studies were 'medium quality', and 8 studies were 'low quality'.Thirty studies showed that sleep deprivation could induce postoperative pain sensitization. Only 2 studies suggested that sleep disorders were not significantly associated with postoperative pain sensitization, and ten studies were uncertain whether sleep deprivation could induce postoperative pain sensitization.ConclusionsOverall evidence shows that sleep deprivation can induce postoperative pain sensitization, but the evaluation dimensions are limited and the methodological quality of the included literature needs to be improved. More high-quality, large-sample and standardized clinical studies should be carried out in the future to provide better scientific basis for clinical work.

Background Postoperative sore throat(POST)is one of the common mild but unpleasant postoperative complications after general anaesthesia.There is evidence that Glycyrrhiza Radix can effectively reduce the incidence of POST,but its effective fraction remains unclear.Objective To screen the effective fraction of Glycyrrhiza Radix on preventing respiratory tract injury induced by endotracheal intubation.Methods From April 2021 to July 2022,60 SPF-grade Wistar rats were randomized into the control group,endotracheal intubation group,lidocaine group,total polysaccharides group,total saponins group,total flavonoids group based on random number table method,with 10 rats in each group.The endotracheal intubation model was prepared for all groups except the control group.Before intubation,each treatment group was sprayed with a solution consisting of 1%lidocaine,total polysaccharides,total saponins,and total flavonoids at 1 mL/100 g(by body weight)to permeate the uvula and peri-soft palate tissue of rats,respectively.The control and endotracheal intubation groups were sprayed with an equal volume of 0.9%saline.After 2 hours of mechanical ventilation,the endotracheal tube was removed,and the pharyngeal mucosa tissues and blood samples of rats were collected under deep anesthesia.Pathological changes of rat pharyngeal mucosa and the expression levels of Toll-like receptor 2(TLR2)and Toll-like receptor 4(TLR4)were observed by hematoxylin-eosin staining(HE staining)and immunohistochemistry(IHC);the expression levels of inflammatory cytokines including serum tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),interleukin-4(IL-4),interleukin-10(IL-10),oxidative stress including superoxide dismutase(SOD),malondialdehyde(MDA),total antioxidant capacity(T-AOC),and stress hormones including cortisol(Cor),epinephrine(E),and norepinephrine(NE)were measured by enzyme-linked immunosorbent assay(ELISA).Results HE staining showed mucosal shedding and severe damage of submucosal structure accompanied by a large number of inflammatory cells infiltrated in the endotracheal intubation group;while milder damage of mucosal structure and less inflammatory cells were significantly reduced in the total saponins group.ELISA results showed that compared with the control group,the levels of TNF-α and IL-2 in the serum of rats increased significantly,and the levels of IL-4 and IL-10 decreased significantly in the endotracheal intubation group(P<0.05);compared with the endotracheal intubation group,the serum levels of TNF-α and IL-2 decreased,and the levels of IL-4 and IL-10 increased in the total saponins group(P<0.05).Compared with the control group,the MDA level in the serum of rats was significantly increased,and the SOD and T-AOC levels were significantly decreased in the endotracheal intubation group(P<0.05);compared with the endotracheal intubation group,the MDA level decreased and the levels of SOD and T-AOC increased in the total saponins and flavonoids groups(P<0.05).Compared with the control group,serum Cor,E,and NE levels significantly increased in the endotracheal intubation group(P<0.05);compared with the tracheal intubation group,serum Cor,E and NE levels were decreased in the total saponins group rats(P<0.05).The IHC results showed that the average optical density(AOD)expressed by TLR2 and TLR4 in the endotracheal intubation group was higher than the control group(P<0.05).The AOD expressed by TLR4 in the pharyngeal mucosal tissue of rats in the total saponins group was significantly lower than that of the endotracheal intubation group(P<0.05).Conclusion Total saponin is the main effective fraction of Glycyrrhiza Radix for the prevention of respiratory tract injury caused by endotracheal intubation under general anesthesia.

Periarthritis of shoulder is a disease characterized by pain and limited range of motion in the shoulder. The underlying pathology is soft tissue fibrosis and inflammation of the shoulder joint, joint capsule, and ligament. It often occurs in middle-aged and elderly people. Nerve block treatment for periarthritis of shoulder's short-term local effect is significant, but the disease is easy to repeat and delay. Platelet-rich plasma (PRP) is increasingly used in many medical fields and in recent years has been used in the treatment of periarthritis of shoulder. Many studies have found that B-ultrasound-guided intraarticular injection of PRP combined with nerve block can effectively improve the symptoms of patients with periarthritis of shoulder. This article mainly reviews the possible pathogenesis of periarthritis of shoulder and the potential mechanism and research progress of PRP combined with nerve block in the treatment of periarthritis of shoulder.

目的 分析自体血回输用于行人工全髋关节置换术老年患者的安全性、有效性及经济性.方法 以2019年3月至2020年3月在甘肃省中医院接受全髋关节置换术的120例患者为研究对象,其中60例术中使用自体血回输,设为观察组,其余60例设为对照组.对比两组手术前后凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、血红蛋白(Hb)和红细胞(RBc)水平,评估自体血回输的有效性;通过分析输血并发症、感染率,评估自体血回输的安全性.结果 观察组Hb、RBc改善情况优于对照组,所有患者均无输血并发症,术后伤口无感染.结论 老年患者术中使用自体血回输安全性高,临床效果明显,且符合节约用血的理念.

Objective:The research status of randomized controlled trials (RCTs) related to electroacupuncture in the prevention and treatment of postoperative cognitive dysfunction (POCD) was analyzed, and the characteristics of literatures, acupoint selection, and meridian selection were summarized.Methods:We systematacially searched the databases of PubMed, Cochrane library, Web of Science, Embase, CBM, CNKI, VIP, and WanFang, and obtained the related literatures from the establishment of the databases to February 2023.Results:A total of 38 RCT articles were included in the prevention and treatment of POCD by electroacupuncture. According to the characteristics of the literatures included, although the number of studies was still small, the amount of literatures showed an overall increasing trend with time. Most of the journals included were domestic journals, while the international journals of SCI type were few. From the point of view of the support of funding projects, in recent years, the state also had more funding support for the clinical research of electroacupuncture treatment of POCD. From the type of funding, provincial, municipal, and national projects occupied the main part, while the proportion of university projects showed less. According to the clinical observation indexes, it was mainly concerned on reducing the incidence of POCD, improving the cognitive function score, and reducing the expressions of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1β, and S100β. From the law of acupoint selection, it was found that the high-frequency acupoints of electroacupuncture for the prevention and treatment of POCD were Neiguan, Baihui, Hegu, Zusanli, Shenting, Shenmen, Sishencong, Sanyinjiao, Taichong, Dazhui, and Benshen acupoints. The high-frequency meridians selected were Governor Meridian, hand Jueyin pericardial Meridian, hand Yang Yin Colorectal Meridian, foot Yangming stomach Meridian, hand Shaoyin Heart Meridian, strange acupoints, foot Shaoyang gallbladder Meridian, foot Taiyin spleen Meridian and Jueyin liver Meridian, and foot Taiyang bladder Meridian and foot Shaoyin Kidney Meridian.Conclusions:This study summarizes the clinical research status of electroacupuncture in the treatment of POCD and the rules of acupoint selection and meridian selection of electroacupuncture in the treatment of POCD, which has a certain guiding significance for clinical application of electroacupuncture in the treatment of POCD, and provides theoretical basis and reference for follow-up researches.

目的 系统经皮穴位电刺激(TEAS)促进腹腔镜结直肠癌术后胃肠功能恢复的有效性.方法 计算机检索PubMed、Cochrane library、Web of Science、Embase、中国生物医学数据库、中国知网、维普和万方数据库,检索时间为从建库至 2022 年 7 月,收集TEAS用于腹腔镜结直肠癌手术的随机对照研究(RCT),由 2 名研究员独立筛选文献、提取数据并对纳入研究使用Cochrane风险偏倚评估工具进行质量评价,采用RevMan 5.3 软件进行Meta分析.结果 共纳入 12 篇RCT,患者 980例,TEAS组 503 例,对照组 477 例.与对照组比较,TEAS组术后首次肛门排气时间(SMD=-1.38,95%CI-1.87～-0.90,P＜0.001)、首次排便时间(SMD=-0.81,95%CI-1.26～-0.36,P＜0.001)和首次闻及肠鸣音时间(SMD=-1.13,95%CI-1.69～-0.57,P＜0.001)均明显缩短,术后恶心呕吐发生率(RR=0.40,95%CI 0.27～0.58,P＜0.001)明显降低,术后住院时间(MD=-1.72 d,95%CI-3.22～-0.22 d,P=0.02)明显缩短.结论 TEAS可有效促进腹腔镜结直肠癌术后胃肠功能恢复,缩短术后住院时间.

With the aggravation of the aging population in China, the incidence rate of malignant tumors remains high. More and more patients with malignant tumors choose surgical treatment, which makes the clinical blood demand increase day by day. In order to relieve the pressure of clinical blood use, various blood protection methods emerge in endlessly. Intraoperative cell salvage（IOCS） is one of the most widely used and cost-effective methods in recent years. It has been listed as a routine measure in major operations such as heart and trauma. Malignant tumors usually have extensive blood supply, large surgical trauma and a large amount of bleeding. Allogeneic blood transfusion is often needed to ensure the safety of patients,but allogeneic blood transfusion is not conducive to the prognosis of patients. Therefore, in recent years, the application of IOCS technology in patients with malignant tumors has been reported, especially the application of combined leukocyte-depleted filter is increasing. This paper reviews the current situation of IOCS in patients with malignant tumors through literature review.

Postoperative sore throat （POST） is a common and easily overlooked complication after endotracheal intubation under general anesthesia. It seriously affects patients satisfaction and the quality of postoperative recovery. However, the consensus on the best drugs or interventions for POST management remains controversial. This study reviews the influencing factors and progress of prevention and treatment of POST intubation under general anesthesia, in order to provide a reference for reducing the incidence of POST after endotracheal intubation under general anesthesia.

目的:应用系统评价/Meta分析方法评价经皮穴位电刺激对老年髋关节置换术后认知功能的影响.方法:系统检索PubMed、Cochrane library、Web of science、Embase、CBM、CNKI、VIP及WanFang数据库中关于经皮穴位电刺激用于髋关节置换手术的研究,时间从建库至2020年10月7日.由2名研究人员背靠背同时筛选文献,提取数据,使用Cochrane风险偏倚评估工具评价纳入研究的质量,并采用RevMan 5.3软件进行Meta分析.结果:共纳入5项随机对照研究,共计344例受试患者,Meta分析结果显示:试验组术后1天简易智能量表(mini-mental state examination,MMSE)评分和术后3天MMSE评分的下降程度、术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率、术后肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和白细胞介素1β(interleukin-1β,IL-1β)的上升水平均低于对照组(P＜0.05).两组患者术后白细胞介素6(interleukin-6,IL-6)的上升水平差异无统计学意义(P＞0.05).结论:经皮穴位电刺激可降低老年髋关节置换术患者POCD的发生率,抑制术后早期炎性因子的释放.

Objective:To systematically evaluate the clinical efficacy and safety of stellate ganglion block for migraine.Methods:The PubMed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, China Science and Technology Journal Database, and WanFang Data were searched for randomized controlled trials on stellate ganglion block in the treatment of migraine from their establishment to September 2022. A risk of bias assessment tool recommended by the Cochrane Handbook was used to evaluate the inherent bias of the included studies. The data were statistically analyzed by the RevMan 5.4 software.Results:In the final meta-analysis, 26 studies with a total of 2 074 patients were included. The results showed that the effective rate in treating migraine in the stellate ganglion block group was higher than that in the control group ( RR=1.21, 95% CI 1.15-1.29, P<0.001). The duration of headache attacks ( MD=-2.80, 95% CI -4.32-1.28, P<0.001) and the headache score of Visual Analogue Scale ( MD=-1.02, 95% CI -1.35-0.68, P<0.001) after the treatment in the stellate ganglion block group were lower than those in the control group. There was no statistical difference in the incidence of adverse reactions between the two groups ( RR=0.98, 95% CI 0.46-2.09, P=0.95). Conclusion:The stellate ganglion block, an effective treatment for migraine, has obvious advantages in terms of reducing headache severity and improving headache duration, and does not increase its related adverse reactions.

As a common neurological disease, cognitive impairment is characterized by cognitive decline, memory and attention impairment, which seriously affects the patients' quality of life. The etiology and pathogenesis of cognitive impairment are complex and diverse. Studies have shown that chronic persistent neuroinflammation plays a key role in its development. Microglia and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome are closely related to neuroinflammation and cognitive impairment. Regulation of microglia and NLRP3 inflammasome can reduce inflammatory factors, reduce amyloid β-protein(Aβ) deposition, regulate autophagy, maintain synaptic homeostasis, thus reducing neuroinflammation and further preventing and treating cognitive impairment. Therefore, exploring the mechanism of microglia and NLRP3 inflammasome as well as their interaction in cognitive impairment can provide some reference and basis for the in-depth study of the mechanism and clinical prevention and treatment of cognitive impairment, and the subsequent development of more efficient drugs.

目的 系统评价经皮穴位电刺激辅助治疗胸腔镜术后疼痛的临床疗效并行Meta分析.方法 计算机检索建库至2021年10月在中国知网、中国生物医学文献数据库、万方数据库、维普数据库、PubMed、Embase、Cochrane Library和Web of Science中发表的经皮穴位电刺激对胸腔镜术后镇痛疗效的随机对照试验.根据纳排标准,由2名研究者独立完成文献筛选和数据提取后进行Meta分析.结果 共纳入10项研究,包含634例患者.Meta分析结果显示,接受经皮穴位电刺激治疗的患者术后6 h、24 h和48 h疼痛视觉模拟量表评分较对照组显著下降[MD=﹣1.74,95％CI(﹣2.61,﹣0.87),P<0.0001;MD=﹣1.61,95％CI(﹣2.56,﹣0.66),P=0.0009;MD=﹣0.79,95％CI(﹣1.16,﹣0.42),P<0.0001],术后镇痛泵按压次数和术后48 h内舒芬太尼用量较对照组明显减少[MD=﹣3.58,95％CI(﹣5.67,﹣1.50),P=0.0008;MD=﹣23.55,95％CI(﹣28.21,﹣18.89),P<0.00001],且术后恶心呕吐发生率较对照组明显降低[RR=0.32,95％CI(0.23,0.45),P<0.00001].结论 经皮穴位电刺激可缓解胸腔镜术后疼痛,减少术后镇痛药物的使用量,降低术后恶心呕吐的发生率.

目的 观察镰形棘豆总黄酮对糖尿病KKay小鼠肾小管上皮细胞转分化的影响.方法 选择糖尿病KKay小鼠模型,分别以低、中、高剂量(0.1、0.2、0.4 g/kg)的镰形棘豆总黄酮每日灌胃1次,连续4周.每天给药前观察动物一般状况;造模的第0、2、4周分别检测记录一般状况、体质量和空腹血糖;第5周时,取肾脏组织进行HE染色,采集的血清中肌酐(creatinine,Cr)、尿素氮(urea nitrogen,BUN)、尿酸(uric acid,UA)含量变化用于评价肾功能以及检测肾间质中的基因、蛋白表达.结果 与模型组比较,镰形棘豆总黄酮可以剂量相关性地减轻糖尿病KKay小鼠的体质量、血糖显著下降(P＜0.05);24 h尿微量白蛋白(UAlb)显著下降,血清中Cr、BUN以及UA均显著降低(P＜0.05);肾脏组织形态学观察肾组织中肾小球数量明显增多,肾小球细胞数目以及肾小球系膜区细胞外基质(extracelluar matrix,ECM)明显减少;抗体E-钙黏连蛋白(E-cadherin)的表达水平有所提高,而α-平滑肌肌动蛋白(α-SMA)的表达显著下降(P＜0.05);肾间质中的I型胶原、Ⅲ型胶原、血清纤维连接蛋白(FN)表达下降(P＜0.05).结论 镰形棘豆总黄酮能够提升体质量,降低血糖,显著降低Cr、BUN以及UA,抑制肾组织中肾小球凋亡,降低肾小球细胞数目以及ECM,一定程度上提高E-cad-herin的表达水平,抑制α-SMA的表达,提示镰形棘豆总黄酮具有抑制肾小管上皮细胞转分化的作用.

目的 探究当归多糖减轻大鼠肢体缺血再灌注后肝损伤及其可能的分子机制.方法 60只健康SD大鼠随机分为正常对照组、模型组、阳性对照组,当归多糖低、中、高剂量组,通过大鼠肢体缺血再灌注损伤造模并给予当归多糖处理,并以依达拉奉作为阳性对照,检测大鼠肝脏苏木素-伊红(HE)染色、原位末端凋亡法(TUNEL)染色比较不同组大鼠肝损伤程度,进一步检测炎症反应相关因子甲基丙二醇(MPO)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β水平及血红素氧合酶(HO)-1/核因子E2相关因子(Nrf)2、人Toll样受体(TLR)4/核转录因子(NF)-κB通路的激活水平探究当归多糖的肝脏保护效应的作用机制.结果 在阳性对照组、当归多糖各剂量组肝脏指数显著低于模型组(P<0.01),肝脏中细胞坏死较模型组明显改善,炎症细胞浸润减少,TUENL染色阳性的凋亡细胞数量亦显著低于模型组(P<0.01),肢体缺血再灌注后的血清炎症相关因子MPO、TNF-α,IL-1β水平显著低于模型组(P<0.01).当归多糖中剂量组较当归多糖低剂量组上述肝损伤指标改善明显(P<0.05),而当归多糖中剂量组和高剂量组差异无统计学意义(P>0.05).最后分子水平结果显示,当归多糖可下调TLR4/NF-κB炎症信号通路,促进HO-1/Nrf2通路.结论 当归多糖通过下调TLR4/NF-κB炎症信号通路,促进HO-1/Nrf2通路抑制炎症反应和氧化应激水平,减轻肢体缺血再灌注后肝损伤.

异相睡眠剥夺(PSD)与术后疼痛的发生密切相关,其机制尚未明确.近年来研究发现,脑源性神经营养因子(BDNF)是PSD的重要调节因子.BDNF/酪氨酸激酶受体B(TrkB)信号通路在PSD致术后痛觉敏化中的作用也被逐渐认识,本文对BD-NF/TrkB 通路参与PSD致术后痛觉敏化的相关研究现状做一综述,以期为PSD致术后痛觉敏化的临床预防及治疗提供新方向.

目的 探讨老年全髋关节置换术中应用自体血回输的临床效果及安全性.方法 100例接受全髋关节置换术且术中输血的老年患者为研究对象,根据术中是否进行自体血回输分为观察组与对照组,每组50例.观察组患者术中应用自体血回输,对照组患者术中输注异体血.比较两组患者的血常规相关指标[血红蛋白(Hb)、红细胞(RBC)、红细胞比容(HCT)],住院相关指标(住院时间、住院费用、术后24 h出血量),术后不良反应发生情况.结果 手术后24 h,观察组患者的外周血Hb、RBC、HCT水平分别为(113.34±14.42)g/L、(2.98±0.24)×1012/L、(0.294±0.020),均高于对照组的(91.02±10.73)g/L、(2.14±0.54)×1012/L、(0.214±0.010),差异具有统计学意义(P<0.05).观察组患者的住院时间(10.2±2.5)d短于对照组的(13.9±1.4)d,住院费用(1.3±0.2)万元低于对照组的(1.9±0.4)万元,术后24 h出血量(524.25±132.24)ml少于对照组的(853.24±120.54)ml,差异具有统计学意义(P<0.05).术后7 d内,观察组患者的不良反应发生率6.00％低于对照组的20.00％,差异具有统计学意义(P<0.05).结论 与输注异体血相比,老年全髋关节置换术中应用自体血回输能够有效提升Hb、RBC、HCT水平,确保患者机体组织供氧正常,有助于降低患者的住院费用,缩短住院时间,利于医疗资源的循环利用,且安全性较高,能够帮助改善患者预后.

Objective:To evaluate the intervention effect of transcutaneous electrical acupoint stimulation (TEAS) on the recovery of gastrointestinal function in parturients after cesarean section by meta-analysis.Methods:The randomized controlled trials about TEAS on the recovery of gastrointestinal function in parturients after cesarean section were searched from The Cochrane Library, PubMed, Web of Science, EMbase, VIP, CNKI, WanFang Data, and China Biology Medicine disc (CBM) from their establishment to February 27, 2022. The RevMan5.3 software was used to conduct meta-analysis on the included literatures.Results:Eight literatures were included, with 851 parturients who took cesarean section. Meta-analysis showed that compared with routine nursing or sham TEAS, TEAS could shorten the first exhaust time ( MD=-6.97, 95% CI -9.92--4.02, P<0.000 01), the first defecation time ( MD=-12.61,95% CI -20.69--4.53, P=0.002), and bowel sound recovery time,( MD=-3.32, 95% CI -4.76--1.88, P<0.000 01), and reduce the incidences of postoperative abdominal distension ( RR=0.44, 95% CI 0.27-0.69, P=0.000 4) and nausea and vomiting ( RR=0.39, 95% CI 0.26-0.58, P<0.000 01) and hospital stay ( SMD=-0.65, 95% CI -0.83--0.46, P<0.000 01). Conclusion:TEAS is helpful to the recovery of gastrointestinal function after cesarean section, but due to the small number of included literatures, follow-up related studies are still needed to further confirm it.

Objective To systematically evaluate the effects of spinal anesthesia（SA） and general anesthesia（GA） on postoperative delirium in patients with hip fracture.Methods Pubmed, Cochranelibrary, Web of science and Embase databases were systematically searched to collect randomized controlled studies on the effects of SA and GA on postoperative delirium in hip fracture surgery from inception to February 2022. Two researchers independently completed literature screening, data extraction and literature quality evaluation, and meta-analysis was performed using RevMan5.4 software.Results A total of 9 randomized controlled studies were included, with 3235 patients, including 1610 patients in the SA group and 1625 patients in the GA group. Meta-analysis showed that there was no significant difference in the incidence of delirium between SA group and GA group at 4 days and 7 days after operation（RR =1.03, 1.05, 95% CI:0.67-1.60, 0.89-1.25, P ＞0.05）. There was no significant difference in the total hospitalization time and the mortality rate at 3 months after operation between the two groups（ P＞0.05）.Conclusion Compared with GA, SA cannot reduce the incidence of delirium at 4 days and 7 days after hip fracture surgery, mortality at 3 months after surgery, and total hospital stay.

全膝关节置换术后疼痛剧烈,影响患者身心健康及术后关节功能恢复.经皮穴位电刺激是一种非药物和非侵入性治疗方法,因其安全无创伤、操作简单、患者接受度高而成为研究热点.本文回顾近几年相关研究,将经皮穴位电刺激对膝关节置换术后疼痛的疗效、穴位选择、参数设定予以综述,以便临床参考.

目的 比较不同浓度及容量罗哌卡因髋关节囊周围神经(PENG)阻滞用于髋部骨折老年患者体位变动时的镇痛效果.方法 选择腰麻下行髋部骨折手术患者180例,男82例,女98例,年龄65～85岁,BMI 18～28 kg/m2,ASAⅡ或Ⅲ级.采用随机数字表法将患者分为六组:0.45％罗哌卡因20 ml组(A1组)、0.45％罗哌卡因10 ml组(B1组)、0.45％罗哌卡因5 ml组(C1组)、0.25％罗哌卡因20 ml组(A2组)、0.25％罗哌卡因10 ml组(B2组)和0.25％罗哌卡因5 ml组(C2组),每组30例.所有患者均在腰麻前按照上述剂量行超声引导下术侧PENG阻滞.记录神经阻滞前、神经阻滞后5、10 min时静息和活动时NRS评分,记录腰麻摆体位时活动时NRS评分.记录术后当天及第1天股四头肌肌力分级和局麻药中毒、神经损伤、血肿形成等不良反应的发生情况.结果 神经阻滞前六组静息和活动时NRS评分差异无统计学意义.与神经阻滞前比较,神经阻滞后5 min、10 min时A1组、B1组、C1组、A2组和B2组静息和活动时NRS评分均明显降低(P<0.05),神经阻滞后10 min C2组静息和活动时NRS评分明显降低(P<0.05).与神经阻滞后5 min比较,神经阻滞后10 min C2组静息时NRS评分明显降低(P<0.05).与神经阻滞后10 min比较,腰麻摆体位时C1组、C2组活动时NRS评分明显升高(P<0.05).与C1组比较,神经阻滞后5 min、10 min、腰麻摆体位时A1组、B1组活动时NRS评分明显降低(P<0.05),神经阻滞后10 min,腰麻摆体位时C2组活动时NRS评分明显升高(P<0.05).与C2组比较,神经阻滞后5 min、10 min、腰麻摆体时A2组、B2静息和活动时NRS评分均明显降低(P<0.05).术后当天B2组股四头肌肌力完5级例数明显多于A1组、A2组和B1组(P<0.05).六组均无局麻药中毒、神经损伤、血肿形成等不良反应发生.结论 超声引导下PENG阻滞对髋部骨折患者麻醉前体位变动有良好的镇痛效果,0.25％罗哌卡因10 ml可提供良好镇痛的效果,对股四头肌肌力影响更小,且不增加不良反应.