摘要：目的 探討不同浓度罗哌卡因在超声引导下髂筋膜阻滞（血管下法）联合骶旁坐骨神经阻滞对老年髋关节手术的麻醉效果。方法 选取2019年8月至2020年10月在柳州市人民医院行髋关节置换的老年患者90例作为研究对象，按随机数表法分为A组（罗哌卡因浓度0.25%）、B组（罗哌卡因浓度0.375%）和C组（罗哌卡因浓度0.5%），每组各30例，行髂筋膜阻滞（血管下法）联合骶旁坐骨神经阻滞，且均在超声引导下实施麻醉，术中小剂量丙泊酚（2-3mg/kg/h）镇静维持，根据需要追加舒芬太尼、瑞芬太尼镇痛维持，脑电双频指数BIS监测麻醉深度维持值在60。记录术中阿片类药物舒芬太尼、瑞芬太尼的使用情况;术后1 h、6 h、12 h采用疼痛视觉模拟评分法（VAS）评估患者静息镇痛效果;记录术后不良反应的发生情况。结果 A组术中需要追加舒芬太尼、瑞芬太尼的量明显高于B、C组（P<0.05），且后两组不需使用舒芬太尼;术后6 h、12 h，3组静息VAS的评分值均较手术结束后1 h升高（P<0.05），各时间点静息VAS的评分A组>B组>C组（P<0.05）。结论 老年患者的髋关节置换手术可以应用罗哌卡因在超声引导行髂筋膜阻滞（血管下法）联合骶旁坐骨神经阻滞下顺利完成，0.375%、0.5%浓度罗哌卡因阻滞效果优于0.25%，且可减少术中阿片类药物的用量;0.375%、0.5%浓度的罗哌卡因阻滞效果相当，但后者阻滞时间更长，值得临床推广应用。

关键词：超声;不同浓度;罗哌卡因;髂筋膜;坐骨神经;麻醉效果

[Abstract] Objective To investigate the anesthetic effect of different concentrations of ropivacaine in ultrasound-guided iliac fascia block combined with paracral sciatic nerve block in elderly hip surgery. Methods A total of 90 elderly patients who underwent hip arthroplasty in Liuzhou People's Hospital from August 2019 to October 2020 were selected as the study subjects. They were divided into group A （ropivacaine concentration 0.25%），group B （ropivacaine concentration 0.375%） and group C （ropivacaine concentration 0.5%） according to random number table method，with 30 patients in each group. Iliac fascia block （vascular method） and paracral sciatic nerve block were performed，and anesthesia was performed under the guidance of ultrasound. A small dose of propofol （2-3mg/kg/h） was used for sedation maintenance，and additional sufentanil and remifentanil were used for analgesia maintenance as required. BIS was used to monitor the maintenance value of anesthesia depth at 60. Intraoperative use of opioids sufentanil and remifentanil was recorded. Visual analogue scale （VAS） was used to evaluate the analgesic effect at 1 h，6 h and 12 h postoperatively. The incidence of postoperative adverse reactions was recorded. Results The amount of additional sufentanil and remifentanil in group A was significantly higher than that in group B and C （P < 0.05），and sufentanil was not needed in the latter two groups. At 6 h and 12 h after surgery，the resting VAS scores of the three groups were higher than those of 1 h after surgery （P < 0.05），and the resting VAS scores of group A > group B > Group C at each time point （P < 0.05）. Conclusions Ropivacaine can be used for hip replacement in elderly patients under ultrasound-guided iliac fascia block （vascular method） combined with paracral sciatic nerve block. The blocking effect of 0.375% and 0.5% ropivacaine is better than 0.25%，and the amount of opioids can be reduced during the operation. The blocking effect of 0.375% and 0.5% ropivacaine is similar，but the latter has a longer blocking time，which is worthy of clinical application.