布比卡因和罗哌卡因局部浸润镇痛在膝关节置换中的应用效果比较  

Comparison of the effects of local infiltration and analgesia with bupivacaine and ropivacaine in knee replacement

作　　者：张晓凡 刘罡 蔡云亮[2] 孙振和 ZHANG Xiao-fan;LIU Gang;CAI Yun-liang;SUN Zhen-he(Department of Anesthesiology,the Fifth People's Hospital,Longgang District,Shenzhen 518111,Guangdong,China;不详)

机构地区：[1]深圳市龙岗区第五人民医院麻醉科,广东深圳518111 [2]深圳市龙岗区人民医院麻醉科,广东深圳518172

出　　处：《广东医学》2019年第22期3127-3130,共4页Guangdong Medical Journal

基　　金：深圳市龙岗区经济与科技发展专项基金项目(编号:LHKCYLWS2018000039)

摘　　要：目的评价布比卡因和罗哌卡因局部浸润镇痛在膝关节置换中术后的镇痛效果及安全性。方法选取行初次单侧膝关节置换的患者共50例,随机分为布比卡因组和罗哌卡因组,用药方案为布比卡因组为0.75%布比卡因10 mL+吗啡1 mg+肾上腺素1 mg,罗哌卡因组为0.75%布比卡因10 mL+吗啡1 mg+肾上腺素1 mg,对比术前术后不同时间点的疼痛VAS评分,比较两组患者术前和术后膝关节主动和被动膝关节活动范围,比较术前和术后3 d的股四头肌肉肌力情况,记录所有患者的不良反应情况。结果两组患者术前HSS评分、手术时间和术中出血量比较差异无统计学意义(P>0.05),布比卡因组和罗哌卡因组患者术前和术后6、12、24、48和72 h的VAS评分比较差异均无统计学意义(P>0.05),罗哌卡因组术后3 d膝关节主动活动范围显著高于布比卡因组,差异有统计学意义(t=4.619,P<0.05),术后24、48和72 h罗哌卡因组的肌力显著高于布比卡因组,两组各项不良反应和总不良反应的对比差异无统计学意义(P>0.05)。结论布比卡因和罗哌卡因局部浸润镇痛在膝关节置换中术后的镇痛效果相当,两组药物安全性良好,罗哌卡因可更好地促进膝关节置换中术后的主动活动范围。Objective To evaluate the analgesic effect and safety of bupivacaine and ropivacaine in local infiltration and analgesia after knee joint replacement.Methods A total of 50 patients with unilateral knee replacement from January 2018 to December 2018 were randomly divided into bupivacaine group and ropivacaine group.The VAS score of the pain at different time points before and after operation was compared.The active and passive knee joint activities of the knee joint were compared between the two groups before and after operation.The postoperative quadriceps muscle strength 3 days after operation was compared.Adverse reactions were recorded.Results There was no significant difference in preoperative HSS score,operation time and intraoperative blood loss between the two groups(P>0.05).The active range of the knee in the ropivacaine group was significantly higher than that in the bupivacaine group(t=4.619,P<0.05).The muscle strength of ropivacaine group was significantly higher than that of bupivacaine group at 48 h and 72 h postoperatively.There was no significant difference between the two groups in both adverse reactions and the total adverse reactions(P>0.05).Conclusion The analgesic effects of bupivacaine and ropivacaine during knee arthroplasty are similar and safe.Ropivacaine could promote the postoperative active range of activities of knee.

关 键 词：布比卡因 罗哌卡因 局部浸润镇痛 膝关节置换 效果 

分 类 号：R614[医药卫生—麻醉学] R68[医药卫生—外科学]