静注地塞米松联合超声引导下右美托咪定复合罗哌卡因肋间神经阻滞在肋骨骨折切开复位术后镇痛效果  

Analgesic effect of intravenous dexamethasone combined with ultrasound⁃guided dexmedetomidine and ropivacaine intercostal nerve block after open reduction of rib fractures

作　　者：王敏[1] 刘婷[1] 贾暄东 WANG Min;LIU Ting;JIA Xuan-dong(Department of Anesthesiology,904th Hospital of Chinese People’s Liberation Army Joint Logis-tic Support Force,Wuxi 214000,China)

机构地区：[1]中国人民解放军联勤保障部队第九零四医院麻醉科,江苏无锡214000

出　　处：《哈尔滨医科大学学报》2023年第3期293-298,共6页Journal of Harbin Medical University

基　　金：江苏省自然科学基金资助项目(20190193)。

摘　　要：目的探讨静注地塞米松联合超声引导下右美托咪定复合罗哌卡因肋间神经阻滞在肋骨骨折切开复位术后镇痛效果。方法选择2019年3月~2022年1月本院收治的89例行肋骨骨折切开复位术患者为研究对象,以随机数字表法分为对照组(n=45)与联合组(n=44)。对照组术后即刻采用超声引导下右美托咪定复合罗哌卡因肋间神经阻滞,联合组术后即刻采用静注地塞米松联合超声引导下右美托咪定复合罗哌卡因肋间神经阻滞,比较两组围术期相关指标,比较两组术前(T0)、术后2 h(T1)、术后24 h(T2)、术后48 h(T3)第1秒用力呼气量(forced expiratory volume in the first second,FEV1)、每分钟最大通气量(maximum ventilation per minute,MVV)、外周血CD4^(+)水平与视觉模拟评分法(visual analogue scale,VAS)评分,比较两组麻醉相关的不良反应。结果联合组麻醉时间长于对照组(P<0.05),术后静脉自控镇痛药物的用药量低于对照组(P<0.05),两组手术时间、拔管时间及住院时间比较差异无统计学意义(P>0.05);T0时刻,两组FEV1、MVV、CD4^(+)水平比较差异无统计学意义(P>0.05);T0时刻,两组FEV1、MVV、CD4^(+)水平均高于T1、T2、T3时刻(P<0.05);T3时刻,两组FEV1、MVV、CD4^(+)水平均高于T1、T2时刻(P<0.05);T2时刻,两组FEV1、MVV、CD4^(+)水平均高于T1时刻(P<0.05);T1、T2、T3时刻,联合组FEV1、MVV、CD4^(+)水平均高于对照组(P<0.05);T0时刻,两组VAS评分比较差异无统计学意义(P>0.05);T0时刻,两组VAS评分均高于T1、T2、T3时刻(P<0.05);T1时刻,两组VAS评分均高于T2、T3时刻(P<0.05);T2时刻,两组VAS评分均高于T3时刻(P<0.05);T1、T2、T3时刻,联合组VAS评分均低于对照组(P<0.05)。两组麻醉相关的总不良反应发生率比较差异无统计学意义(P>0.05)。结论静注地塞米松联合超声引导下右美托咪定复合罗哌卡因肋间神经阻滞对肋骨骨折切开复位术后患者免疫抑制轻、镇痛效果明显,对患者肺功�Objective To investigate the analgesic effect of intravenous dexamethasone com⁃bined with ultrasound⁃guided dexmedetomidine and ropivacaine intercostal nerve block after open reduction of rib fractures.Methods A total of 89 patients with open reduction of rib fractures admitted to our hospital from March 2019 to January 2022 were selected as the re⁃search subjects,and divided into the control group(n=45)and the combined group(n=44)by random number table method.The control group received ultrasound⁃guided dexmedetomi⁃dine combined with ropivacaine intercostal nerve block immediately after operation,and the combined group received intravenous dexmedetomidine combined with ultrasound⁃guided dexmedetomidine and ropivacaine intercostal nerve block immediately after operation.The peri⁃operative related indicators of two groups were compared.The forced expiratory volume in the first second(FEV1)and maximum ventilation per minute(MVV),peripheral blood CD4^(+)level and visual analogue scale(VAS)score were compared between the two groups before surgery(T0),2 hours after surgery(T1),24 hours after surgery(T2),and 48 hours after surgery(T3).Anesthesia⁃related adverse reactions were compared between the two groups.Results The anesthesia time in the combined group was longer than that in the control group(P<0.05),and the dosage of postoperative patient⁃controlled intravenous analgesia in the com⁃bined group was lower than that in the control group(P<0.05),and there was no significant difference in the operation time,extubation time and hospitalization time between the two groups(P>0.05).At T0,there was no significant difference in the levels of FEV1,MVV and CD4^(+)between the two groups(P>0.05).At T0,the levels of FEV1,MVV and CD4^(+)in the two groups were higher than those at T1,T2 and T3(P<0.05).At T3,the levels of FEV1,MVV and CD4^(+)in the two groups were higher than those at T1 and T2(P<0.05).At T2,the levels of FEV1,MVV and CD4^(+)in the two groups were higher than those at T1(P<0.05).At T1,T2 and T3,

关 键 词：地塞米松 超声引导 右美托咪定 罗哌卡因 肋间神经阻滞 肋骨骨折切开复位术 镇痛效果 

分 类 号：R683.1[医药卫生—骨科学] R614.4[医药卫生—外科学]