不同剂量右美托咪定复合罗哌卡因收肌管阻滞对膝关节置换术后镇痛效果的影响  

ANALGESIC EFFECT OF DIFFERENT DOSES OF DEXMEDETOMIDINE COMBINED WITH ROPIVACAINE FOR ADDUCTOR CANAL BLOCK AFTER KNEE ARTHROPLASTY

作　　者：桑慧 马晓军[1] 刘勇波[1] 黄辉[1] 徐晓林[1] 刘英志[1] SANG Hui;MA Xiaojun;LIU Yongbo;HUANG Hui;XU Xiaolin;LIU Yingzhi(Department of Anesthesiology,The Affiliated Hospital of Qingdao University,Qingdao 266100,China)

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266100 [2]菏泽市第二人民医院麻醉科

出　　处：《青岛大学学报（医学版）》2020年第1期67-71,共5页Journal of Qingdao University(Medical Sciences)

基　　金：青岛市公共领域科技支撑计划项目(11-2-3-1-(16)-nsh)

摘　　要：目的探讨不同剂量右美托咪定复合罗哌卡因超声引导下收肌管阻滞在膝关节置换术后镇痛中的应用价值。方法2018年3—9月,选择在青岛大学附属医院手术室行单侧膝关节置换术的病人120例,随机分为4组,每组30例。4组均于全身麻醉诱导前30 min行超声引导下收肌管阻滞:A组给予3.75 g/L罗哌卡因20 mL;B组给予0.50μg/kg右美托咪定+3.75 g/L罗哌卡因20 mL;C组给予0.75μg/kg右美托咪定+3.75 g/L罗哌卡因20 mL;D组给予1.00μg/kg右美托咪定+3.75 g/L罗哌卡因20 mL。术毕使用静脉镇痛泵镇痛。观察各组手术后6、12、24、48 h的视觉模拟评分法(VAS)疼痛评分和Ramsay镇静评分;记录各组术后48 h内曲马多用量和镇痛泵有效按压次数;比较各组病人术后满意度和不良事件发生率。结果术后6、12 h,B、C、D组病人VAS疼痛评分显著低于A组,C、D组病人VAS疼痛评分显著低于B组(F=2.98、3.45,P<0.05)。术后不同时间点各组Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。B、C、D组病人术后48 h内曲马多用量、镇痛泵有效按压次数均明显低于A组(F=10.26、62.84,P<0.05)。B、C、D组病人术后满意度均显著高于A组(Z=2.09~3.04,P<0.05)。各组病人术后低血压、呼吸抑制和心动过缓发生率比较,差异无统计学意义(P>0.05)。结论0.75μg/kg右美托咪定复合3.75 g/L罗哌卡因20 mL收肌管阻滞能有效缓解膝关节置换术后疼痛,提高病人术后满意度,减少术后镇痛药物的用量。Objective To investigate the value of different doses of dexmedetomidine combined with ropivacaine for adductor canal block in analgesia after knee arthroplasty.Methods A total of 120 patients who underwent unilateral knee arthroplasty in the operating room of The Affiliated Hospital of Qingdao University from March to September,2018,were enrolled and randomly divided into groups A,B,C,and D,with 30 patients in each group.All patients were given ultrasound-guided adductor canal block at 30 min before the induction of general anesthesia:the patients in group A were given 3.75 g/L ropivacaine 20 mL;the patients in group B were given 0.50μg/kg dexmedetomidine+3.75 g/L ropivacaine 20 mL;the patients in group C were given 0.75μg/kg dexmedetomidine+3.75 g/L ropivacaine 20 mL;the patients in group D were given 1.00μg/kg dexmedetomidine+3.75 g/L ropivacaine 20 mL.An intravenous analgesia pump was used for analgesia after surgery.Visual Analogue Scale(VAS)score and Ramsay sedation score were observed at 6,12,24,and 48 h after surgery.The amount of tramadol and the number of effective pressings of the intravenous analgesia pump were recorded within 48 h after surgery.The four groups were compared in terms of degree of satisfaction and incidence rate of adverse events after surgery.Results At 6 and 12 h after surgery,groups B,C,and D had a significantly lower VAS score than group A,and groups C and D had a significantly lower VAS score than group B(F=2.98,3.45;P<0.05).There was no significant difference in Ramsay sedation score between the four groups at each time point after surgery(P>0.05).Group B,C and D had significantly lower amount of tramadol and number of effective intravenous analgesia pump pressings than group A at 48 h after surgery(F=10.26,62.84;P<0.05).Groups B,C,and D had a significantly higher degree of satisfaction than group A(Z=2.09-3.04,P<0.05).There were no significant differences in the incidence rates of postoperative hypotension,respiratory depression,and bradycardia between the four groups(P>0.05)

关 键 词：收肌管阻滞 右美托咪定 罗哌卡因 关节成形术 置换 膝 镇痛 

分 类 号：R614.4[医药卫生—麻醉学]