超声引导下髂筋膜间隙阻滞对老年全髋关节置换术后镇痛及应激反应的影响  

Influence of ultrasound-guided iliac interfascial space block with dexmedetomidine combined with ropivacaine on postoperative analgesia and stress reaction in elderly patients with total hip arthroplasty

作　　者：吴震[1] 温来友[1] 陈建庆[1] 乐伟[1] 宋文祥 李颖 

机构地区：[1]东南大学医学院附属江阴医院麻醉科,南京214400

出　　处：《检验医学与临床》2017年第19期2830-2832,2835,共4页Laboratory Medicine and Clinic

基　　金：江苏省无锡市卫生和计划生育委员会课题资助项目(MS201531)

摘　　要：目的评价超声引导下右美托咪啶联合罗哌卡因髂筋膜间隙阻滞用于老年全髋关节置换术患者镇痛的效果及对术后应激反应的影响。方法选取90例全髋关节置换术患者随机分为罗哌卡因组(R组)、右美托咪啶联合罗哌卡因组(DR组)和舒芬太尼组(S组),每组30例。R组:0.200%罗哌卡因30mL加生理盐水至200mL;DR组:1μg/kg右美托咪啶+0.200%罗哌卡因30mL加生理盐水至200mL;S组:2μg/kg舒芬太尼200mL。R组和DR组行髂筋膜间隙置管后连续镇痛,S组行静脉自控镇痛。观察术后4、8、12、24h静息、活动视觉模拟评分(VAS)和镇静评分(Ramsay),记录入室时(T1)、术后第1天清晨7:00(T2)、第2天清晨7:00(T3)血皮质醇(Cor)与血糖(Glu)水平。观察术后不良反应。结果 DR组和R组患者在各时点的静息和活动VAS评分均低于S组,差异有统计学意义(P<0.05);DR组在各时点的活动VAS评分低于R组和S组,差异有统计学意义(P<0.05)。Cor与Glu水平比较,各组患者T1时比较差异无统计学意义(P>0.05),DR组和R组T2、T3时均低于S组(P<0.05),DR组明显低于R组,差异均有统计学意义(P<0.05)。三组Ramsay评分比较差异无统计学意义(P>0.05),三组不良反应比较差异无统计学意义(P>0.05)。结论超声引导下右美托咪啶联合罗哌卡因髂筋膜间隙阻滞用于老年全髋关节置换术可明显减轻术后疼痛,抑制术后应激反应。Objective To evaluate the efficacy of ultrasound-guided iliac interfascial space block with dexmedetomidine combined with ropivacaine on analgesia and its influence on postoperative stress reaction in elderly patients with total hip arthroplasty（THA）.Methods Sixty cases of THA were randomly divided into：the ropivacaine group（R）,dexmedetomidine combined with ropivacaine group（DR）and sufentanil group（S）,30 cases in each group.The group R：0.200% ropivacaine 30 mL adding normal saline to 200mL;group DR：1μg/kg dexmedetomidine＋0.200% ropivacaine 30 mL adding normal saline to 200 mL;group S：sufentanil 2μg/kg 200 mL.Continuous analgesia after catheter insertion of iliac interfascial space was performed in the group R and DR,while the group S conducted the patient-controlled intravenous analgesia（PCIA）.The resting and motion visual analogue scale（VAS）scores,Ramsay sedation scores at postoperative 4,8,12,24 hwere observed.The levels of cortisol（Cor）and blood glucose（Glu）were recorded at the time points of entering the operation room（T1）,at 7o＇clock on the morning of postoperative 1d（T2）,7o＇clock in the second day morning after operation（T3）.The adverse reactions after operation were recorded.Results The resting and motion VAS scores at each time point in the group DR and R were lower than those in the group S,the difference was statistically significant（P〈0.05）,and the VAS scores in the group DR were lower than those in the group R and S,the differece was statistically significant（P〈0.05）.The Cor and Glu levels at T1 had no statistically significant difference among the three groups（P〉0.05）,which at T2,T3 in the group DR and R were lower than those in the group S,the difference was statistically significant（P〈0.05）,and those in the group DR were significantly lower than those in the group R,the difference was statistically significant（P〉0.05）.The Ramsay sedation score had no statistically significant difference among the three groups�

关 键 词：超声引导 右美托咪啶 髂筋膜间隙阻滞 全髋关节置换术 

分 类 号：R687.4[医药卫生—骨科学]