硫酸镁联合罗哌卡因髂筋膜阻滞对全膝关节置换手术止血带反应的疗效观察  

Effect of magnesium sulfate combined with ropivacaine iliac fascia block on tourniquet reaction in total knee replacement surger

作　　者：庞文广 刘莉[2] PANG Wenguang;LIU Li(Tianjin First Central Hospital,Tianjin 300192,China;Cangzhou Hospital of Integrated Chinese and Western Medicine,Cangzhou 061000,China)

机构地区：[1]天津市第一中心医院,天津300192 [2]河北省沧州中西医结合医院,河北沧州061000

出　　处：《临床医药实践》2024年第3期187-190,213,共5页Proceeding of Clinical Medicine

摘　　要：目的:分析硫酸镁联合罗哌卡因髂筋膜阻滞对全膝关节置换术(TKA)止血带反应的影响。方法:选取2020年5月—2023年5月就诊的TKA患者90例,根据麻醉方法不同分为对照组和观察组,每组45例。对照组给予罗哌卡因髂筋膜阻滞,观察组在对照组基础上给予硫酸镁静脉滴注,对比两组不同时间点心率(HR)、平均动脉压(MAP)、炎症应激指标、罗哌卡因累积用量、镇痛泵按压次数、不良反应总发生率。结果:观察组止血带充气即刻(t_(1))HR,MAP与对照组比较,差异无统计学意义(P>0.05);观察组充气30 min后(t_(2))、充气60 min后(t_(3))、充气90 min后(t_(4))、松止血带时(t_(5))、拔管后(t_(6))HR,MAP均低于对照组,差异有统计学意义(P<0.05)。观察组术后24 h血清超氧化物歧化酶(SOD)水平高于对照组,血清丙二醛(MDA)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平均低于对照组,差异均有统计学意义(P<0.05)。观察组罗哌卡因累积用量、镇痛泵按压次数均低于对照组,差异均有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:硫酸镁联合罗哌卡因髂筋膜阻滞可有效维持TKA患者术中血流动力学稳定,减轻止血带反应,抑制炎症及氧化因子释放,且未引发严重不良反应。Objective:To analyze the effect of magnesium sulfate combined with ropivacaine iliac fascia block on tourniquet reaction during total knee replacement(TKA).Methods:A total of 90 TKA patients treated in our hospital from May 2020 to May 2023 were selected for this study,and divided into 2 groups with 45 cases each according to different anesthesia methods.The control group was given ropivacaine iliac fascial block,and the observation group was given magnesium sulfate intravenous infusion on the basis of the comparison group.Heart rate(HR),mean arterial pressure(MAP),inflammatory stress index,cumulative dosage of ropivacaine,number of analgesic pump compressions and total incidence of adverse reactions were compared between the two groups at different time points.Results:t_(1) HR and MAP in observation group were compared with those in comparison group,there was significient difference(P>0.05).HR and MAP of 30 min after aeration(t_(2)),60 min after aeration(t_(3)),90 min after aeration(t_(4)),when tourniquet was loosened(t_(5))and after extubation(t_(6))in observation group were lower than those in comparison group(P<0.05).The level of serum superoxide dismutase(SOD)in the observation group was higher than that in the control group 24 h after surgery,and the levels of serum malondialdehyde(MDA),interleukin-6(IL-6)and C-reactive protein(CRP)in the observation group 24h after surgery were lower than those in the control group(P<0.05).The cumulative dosage of ropivacaine and The Times of analgesic pump in observation group were lower than those in control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Magnesium sulfate combined with ropivacaine iliac fascia block can effectively maintain hemodynamic stability in patients with TKA during operation,alleviate tourniquet reaction,inhibit inflammation and oxidative factor release,and do not cause serious adverse reactions,so it has certain safety.

关 键 词：硫酸镁 罗哌卡因髂筋膜阻滞 全膝关节置换术 止血带反应 

分 类 号：R614.2[医药卫生—麻醉学]