老年全髋关节置换关节囊周围神经阻滞中右美托咪定与罗哌卡因的量效关系  

Dose-effect relationship between dexmedetomidine and ropivacaine during pericapsular nerve group block in elderly patients undergoing total hip arthroplasty

作　　者：李远峰 叶溥锋 潘桂烽 麦振江 Li Yuanfeng;Ye Pufeng;Pan Guifeng;Mai Zhenjiang(Dongguan Hospital,Guangzhou University of Chinese Medicine,Dongguan 523000,Guangdong Province,China)

机构地区：[1]广州中医药大学东莞医院,广东省东莞市523000

出　　处：《中国组织工程研究》2025年第21期4514-4520,共7页Chinese Journal of Tissue Engineering Research

基　　金：广州中医药大学东莞医院对此次研究的支持。

摘　　要：背景:右美托咪定和罗哌卡因是2种常用于老年全髋关节置换过程中的局部麻醉药物和辅助药物,可在行髋关节周围神经阻滞中提供镇静和止痛效果。目的:探究右美托咪定与罗哌卡因在老年全髋关节置换患者髋关节囊周围神经阻滞中持续镇静的量效关系。方法:按倾向性匹配法进行1∶1匹配,选择2021年1月至2023年1月在广州中医药大学东莞医院接受全髋关节置换治疗的120例老年患者为研究对象,匹配后分为2组,观察组60例给予罗哌卡因和1μg/kg右美托咪定的混合液20 mL行髋关节囊周围神经阻滞,对照组60例给予罗哌卡因20 mL行髋关节囊周围神经阻滞。对比分析两组患者的一般资料、围术期指标、术后镇痛情况、血流动力学指标、炎性因子、应激指标、麻醉后不良反应、住院时间及术后并发症发生情况。采用Probit法计算罗哌卡因髋关节囊周围神经阻滞的半数有效药物剂量及95%有效药物剂量。结果与结论:(1)观察组术后镇痛情况优于对照组,两组在术后6 h动态、12 h静息、12 h动态、24 h静息、24 h动态、48 h静息、48 h动态的目测类比评分以及首次按压静脉连接患者自控镇痛泵时间、术后24,48 h按压患者自控镇痛泵次数间差异有显著性意义(P <0.05);(2)两组患者拔管、术后12 h时的平均动脉压及拔管时的心率相比差异有极显著性意义(P <0.01);(3)术后24,48 h观察组的白细胞介素6、肿瘤坏死因子α、肾上腺素、去甲肾上腺素水平均低于对照组,差异有极显著性意义(P <0.01);(4)两组患者的住院时间相比差异有极显著性意义(P <0.01),术后并发症发生情况无显著性差异(P> 0.05);(5)右美托咪定复合罗哌卡因行髋关节囊周围神经阻滞反应的半数有效药物剂量为0.164%,95%有效药物剂量为0.188%;单纯罗哌卡因行髋关节囊周围神经阻滞反应的半数有效药物剂量为0.194%,95%有效药物剂量为0.276%;(6)提�BACKGROUND:Ropivacaine and dexmedetomidine are two commonly used local anesthetic agents and adjuvants in elderly total hip arthroplasty.They provide sedation and analgesic effects during peripheral hip nerve blocks.OBJECTIVE:To explore the dose-effect relationship between dexmedetomidine and ropivacaine in continuous sedation during pericapsular nerve group block in elderly patients undergoing total hip arthroplasty.METHODS:A total of 120 elderly patients who received total hip arthroplasty in Dongguan Hospital,Guangzhou University of Chinese Medicine from January 2021 to January 2023 were selected as study subjects and randomly divided into two groups 1:1 matching according to propensity matching method.The observation group(n=60)received pericapsular nerve group block by giving 20 mL mixture of ropivacaine and 1μg/kg dexmedetomidine.The control group(n=60)received received pericapsular nerve group block by giving 20 mL of ropivacaine.The general data,perioperative indexes,postoperative analgesia,hemodynamic indexes,inflammatory factors,stress indexes,postoperative adverse reactions,length of hospital stay,and the occurrence of postoperative complications were compared and analyzed between the two groups.The median effective dose and 95%effective dose concentrations of ropivacaine pericapsular nerve group block were calculated by the Probit method.RESULTS AND CONCLUSION:(1)The postoperative analgesia of the observation group was better than that of the control group,and the visual analog scale score at 6-hour dynamic,12-hour static,12-hour dynamic,24-hour static,24-hour dynamic,48-hour static,48-hour dynamic,as well as the time of first patient-controlled analgesia compression and the number of patient-controlled analgesia compression at 24 and 48 hours postoperatively were statistically different(P<0.05).(2)There were significant differences between the two groups in mean arterial pressure and heart rate at extubation and 12 hours after extubation(P<0.01).(3)The levels of interleukin-6,tumor necrosis factor-�

关 键 词：全髋关节置换 右美托咪定 罗哌卡因 髋关节囊周围神经阻滞 持续镇静 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R614