超声引导下右美托咪定联合罗哌卡因腰丛-坐骨神经阻滞在髋关节置换术后的应用效果  

To investigate the effect of ultrasound-guided dexmedetomidine combined with ropivacaine lumbar plexus-sciatic nerve block on analgesia,neurotransmitters and adverse reactions after hip arthroplasty

作　　者：王竹[1] 冯巨贵 杨柳[1] 黄薇 于品仙 WANG Zhu;FENG Ju-gui;YANG Liu(Department of Anesthesiology,Zhanjiang Central People's Hospital,Zhanjiang 524200,China;不详)

机构地区：[1]湛江中心人民医院麻醉科,广东湛江524000 [2]雷州市人民医院麻醉科,广东湛江524200

出　　处：《中国处方药》2023年第9期107-110,共4页Journal of China Prescription Drug

基　　金：2021年度第四批湛江市非资助科技攻关计划项目(2021B01289)。

摘　　要：目的探讨超声引导下右美托咪定联合罗哌卡因腰丛-坐骨神经阻滞(LSNB)在髋关节置换术(HR)后对患者镇痛效果、神经递质及不良反应的影响。方法选择2021年5月~2022年9月行HR术治疗的60例患者,按随机数字表法分为对照组(30例)与观察组(30例)。两组均行超声引导下LSNB麻醉,麻醉药物方案:对照组用罗哌卡因实施阻滞,在此基础上,观察组采用右美托咪定阻滞。对比两组镇痛效果、神经递质、血流动力学、不良反应。结果观察组术后6 h、24 h时静息与运动时视觉模拟评分法(VAS)评分和术后24 h改良Bromage评分均低于对照组,差异有统计学意义(P<0.05);术后24 h时,两组β-内啡肽、P物质与孤啡肽均高于术前,但观察组β-内啡肽、P物质、孤啡肽低于对照组,差异有统计学意义(P<0.05);两组麻醉前(T_(0))、麻醉后10 min(T_(1))时血流动力学各项指标对比,差异无统计学意义(P>0.05),麻醉后20 min(T_(2))时两组HR、平均动脉压(MAP)均低于T_(0)时,混合静脉血氧饱和度(SvO_(2))高于T_(0)时,而观察组心率(HR)、MAP较对照组高,SvO_(2)较对照组低,差异有统计学意义(P<0.05);两组不良反应总发生率对比,差异无统计学意义(P>0.05)。结论超声引导下右美托咪定联合罗哌卡因LSNB可维持HR中血流动力学稳定,降低神经递质水平,提高镇痛效果,安全性较高。Objective To investigate the effect of ultrasound-guided dexmedetomidine combined with ropivacaine lumbar plexus-sciatic nerve block(LSNB)on analgesia,neurotransmitters and adverse reactions in patients after hip replacement(HR).Methods A total of 60 patients who were going to undergo HR surgery in our hospital from May 2021 to February 2022 were selected and divided into the control group(30 cases)and the observation group(30 cases)according to the random number table method.Both groups underwent ultrasound-guided LSNB anesthesia,and the anesthesia drug regimen:the control group was given ropivacaine block,and on this basis,the observation group was given dexmedetomidine block.The analgesic effects,neurotransmitters,hemodynamics,and adverse reactions were compared between the two groups.Results At 6 h and 24 h after operation,the visual analogue scale(VAS)scores at rest and during exercise and the modified Bromage score at 24 h after operation in the observation group were lower than those in the control group,with statistical differences(P<0.05).Theβ-endorphin,substance P and orphan in the group were higher than those before operation,but theβ-endorphin,substance P and orphan in the observation group were lower than those in the control group,with statistical difference(P<0.05);Before anesthesia(T_(0))and 10 minutes after anesthesia(T_(1)),there was no statistical difference in the hemodynamic indexes between the two groups(P>0.05).At 20 minutes after anesthesia(T_(2)),the HR and mean arterial pressure(MAP)of the two groups were lower than T_(0),and the mixed venous oxygen saturation(SvO_(2))was higher than T_(0),while the heart rate(HR)and MAP of the observation group were higher than those of the control group,SvO_(2)was lower than that of the control group,with statistical difference(P<0.05);There was no statistical difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Ultrasound-guided dexmedetomidine combined with ropivacaine LSNB can maintain hemodynamic stabil

关 键 词：髋关节置换术 腰丛-坐骨神经阻滞 右美托咪定 罗哌卡因 镇痛效果 神经递质 

分 类 号：R614[医药卫生—麻醉学]