右美托咪啶辅助连续股神经阻滞对膝关节置换术后镇痛的影响  

Effect of dexmedetomidine-assisted continuous femoral nerve block analgesia after total knee arthroplasty （TKA）

作　　者：张建楠[1] 柳娇[1] 徐敏逸[1] 任晓平[1] 徐永成[1] 尹卫娟[1] 蔡靓羽[1] 周春刚[2] 

机构地区：[1]南京中医药大学无锡附属医院麻醉科,江苏省无锡214071 [2]南京中医药大学无锡附属医院中心实验室,江苏省无锡214071

出　　处：《中国医师杂志》2016年第4期501-504,共4页Journal of Chinese Physician

摘　　要：目的 评价右美托咪啶复合罗哌卡因对全膝关节置换术后连续股神经阻滞镇痛效果的影响.方法 择期行单膝关节置换术患者40例,按随机数字表法分为2组（n=20）：右美托咪啶组（T组）和对照组（C组）.所有患者常规腰硬联合麻醉后,蛛网膜下腔注入0.5％等比重罗哌卡因3ml,术中根据手术需要硬膜外腔追加0.375％罗哌卡因3～5ml.股神经穿刺成功后,T组注入0.375％罗哌卡因＋右美托咪啶混合溶液20 ml（含右美托咪啶0.6 μg,/kg）,C组注入0.375％罗哌卡因20 ml.放置连续股神经阻滞导管,术毕两组患者均连接电子镇痛泵行连续股神经镇痛,采用0.75％罗哌卡因50 ml,加生理盐水稀释至200 ml（每袋）.背景剂量：4ml/h;PCA剂量4ml/次,锁定时间为30 min.记录两组患者术后6、24、48、72 h静息状态VAS疼痛评分（RVAS）和被动活动VAS疼痛评分（PVAS）.采用双抗夹心ELISA法检测麻醉前和术后24、48、72 h血清TNF-α、IL-1β、IL-6等炎性因子水平.记录术后相关不良反应.结果 与C组比较,T组术后6、24、48 h的RVAS和PVAS评分均明显降低（P＜0.05）,T组24和48 h的TNF-α、IL-1β、IL-6炎性因子浓度明显低于C组（P＜0.05）,T组术后窦缓发生率高于C组（P＜0.05）.结论 右美托咪啶复合罗哌卡因镇痛可有效提高TKA术后连续股神经阻滞镇痛效果,降低血清炎症因子水平,减轻术后应激反应.Objective To investigate the effects of dexmedetomidine on ropivacaine for continuous femoral nerve block （CFNB） analgesia after total knee arthroplasty （TKA）.Methods Forty patients after TKA were randomly assigned into two groups of T and C （n =20 cases each group）.All of the patients received spinal-epidural combined anesthesia,subarachnoid injection of 0.5% isobaric ropivacaine 3 ml,intraoperative epidural space according to the need of surgery an extra 0.375% ropivacaine paid for 3 to 5 ml.Postoperative analgesia with continuous femoral nerve block was performed in both groups,after the puncture of femoral nerve,group T was injected with 0.375% ropivacaine ＋ dexmedetomidine mixed solution 20 ml （with dexmedetomidine 0.6 μg/kg）,group C were injected with 0.375% ropivacaine 20 ml.Placement of continuous femoral nerve catheter,two groups of patients were performed operation continuous femoral nerve block analgesia and CFNB with 0.75% ropivacaine 50 ml,added saline diluted to 200 ml （each bag）.Background infusion was 4 ml per hour;the demand dose was 4 ml in a lockout interval of 30 minutes.Two groups of patients were recorded rest visual analogue scale （RVAS） and passive visual analogue scale （PVAS） postoperative 6,24,48 and 72 h.Serum concentration of tumor necrosis factor-α （TNF-α）,interleukin （IL）-1β and IL-6 were measured with double sandwich enzyme-linked immunosorbent assay （ELISA） method before anesthesia and postoperative in 24,48,and 72 hours.Analgesia-related adverse reactions such as delirium,nausea and vomiting,urinary retention were record.Results Compared to group C,postoperative RVAS and PVAS of 6,24 and 48 h wrere significantly decreased （P 〈 0.05）.Postoperative serum concentrations of TNF-α,IL-1β and IL-6 in 24,and 48 hours in group T were lower than those in group C （P 〈 0.05）.Group T incidence of postoperative sinus bradycardia was lower than the group C （P 〈 0.05）.Conclusions Dexmedetomidine combined with ropivacaine analgesia

关 键 词：右美托咪啶/投药和剂量 普鲁卡因/投药和剂量 股神经 神经传导阻滞 关节成形术 置换 膝 镇痛 

分 类 号：R614.4[医药卫生—麻醉学]