不同浓度罗哌卡因混合右美托咪定腰方肌阻滞用于全麻老年患者全髋关节置换术效果的比较  

Comparison of effects of different concentrations of ropivacaine mixed with dexmedetomidine on quadratus lumborum block for total hip replacement in elderly patients undergoing general anesthesia

作　　者：庄欢 何开华[1] Zhuang Huan;He Kaihua(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院麻醉科,400016

出　　处：《中华麻醉学杂志》2020年第10期1213-1216,共4页Chinese Journal of Anesthesiology

基　　金：卫生部国家临床重点专科建设项目(财社[2011]170号)。

摘　　要：目的比较不同浓度罗哌卡因混合右美托咪定腰方肌阻滞用于老年患者全髋关节置换术的效果。方法选取择期行单侧全髋关节置换术患者60例,性别不限,年龄65~85岁,体重40~80 kg,ASA分级Ⅱ或Ⅲ级,依照计算机生成的随机数字表分为2组:0.33%罗哌卡因+1μg/kg右美托咪定组(R1组)和0.25%罗哌卡因+1μg/kg右美托咪定组(R2组),每组30例。麻醉诱导前,R1组和R2组采用浓度为0.33%和0.25%的罗哌卡因+1μg/kg右美托咪定混合液30 ml,行患侧前路腰方肌阻滞。术中采用静吸复合麻醉。术毕行PCIA,配方为氟比洛芬酯100 mg+曲马多800 mg+0.9%氯化钠溶液80 ml,PCA剂量为2 ml,锁定时间为15 min,维持VAS评分≤3分。若VAS评分≥4分,静脉注射曲马多50 mg进行补救镇痛。记录术后72 h内补救镇痛情况和PCA按压次数;记录术后Ⅱ级和Ⅲ级肌力恢复时间、首次下床时间及住院时间;记录术后72 h内恶心呕吐、低血压、窦性心动过缓、穿刺部位血肿和过度镇静的发生情况;记录患者镇痛满意度评分。结果与R1组相比,R2组术后Ⅱ级和Ⅲ级肌力恢复时间、首次下床时间和住院时间缩短(P<0.05),PCA按压次数和术后患者镇痛满意度评分差异无统计学意义(P>0.05)。2组均未进行术后补救镇痛,均未见穿刺部位血肿发生。2组术后恶心呕吐、低血压、窦性心动过缓和过度镇静发生率比较差异无统计学意义(P>0.05)。结论与0.33%罗哌卡因相比,0.25%罗哌卡因混合右美托咪定腰方肌阻滞用于老年患者全髋关节置换术的效果更佳。Objective To compare the effects of different concentrations of ropivacaine mixed with dexmedetomidine on quadratus lumborum block for total hip replacement in elderly patients undergoing general anesthesia.Methods Sixty American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes,aged 65-85 yr,weighing 40-80 kg,undergoing elective unilateral total hip arthroplasty,were selected,and divided into 2 groups according to a computer-generated random number table:0.33%ropivacaine plus 1μg/kg dexmedetomidine group(R1 group)and 0.25%ropivacaine plus 1μg/kg dexmedetomidine group(R2 group),with 30 cases in each group.Before induction of anesthesia,0.33%and 0.25%ropivacaine mixed with 1μg/kg dexmedetomidine 30 ml were used for anterior quadratus lumborum block on the affected side,in R1 group and R2 group,respectively.Combined intravenous-inhalational anesthesia was used during operation.Patient-controlled intravenous analgesia(PCIA)was performed at the end of operation.PCIA solution contained flurbiprofen axetil 100 mg,tramadol 800 mg and 0.9%sodium chloride solution 80 ml.The PCA pump was set up with a 2 ml bolus dose and a 15 min lockout interval,and the visual analogue scale score was maintained≤3.When the visual analogue scale score was≥4,tramadol 50 mg was intravenously injected for rescue analgesia.The requirement for rescue analgesia and pressing times of PCA within 72 h after operation were recorded.The postoperative recovery time of gradeⅡandⅢmuscle strength,the first off-bed time and length of hospital stay were recorded.The occurrence of nausea and vomiting,hypotension,sinus bradycardia,hematoma at the puncture site and oversedation within 72 h after surgery was recorded.The score for patients′satisfaction with analgesia was also recorded.Results Compared with R1 group,the postoperative recovery time of gradeⅡandⅢmuscle strength,the first off-bed time and length of hospital stay were significantly shortened(P<0.05),and no significant change was found in the pressing times

关 键 词：酰胺类 右美托咪啶 神经传导阻滞 腰肌 关节成形术 置换 髋 老年人 

分 类 号：R614[医药卫生—麻醉学]