右美托咪定对下肢手术患者坐骨神经阻滞联合股神经阻滞时罗哌卡因半数效应浓度的影响研究  

Effect of dexmedetomidine on the median effective concentration of ropivacaine during sciatic nerve block combined with femoral nerve block in patients undergoing lower extremity surgery

作　　者：陈祖权 古小平 邹文军 何富强[1] CHEN Zuquan;GU Xiaoping;ZOU Wenjun;HE Fuqiang(Department of Anesthesiology,the Fourth People's Hospital of Sichuan Province,Chengdu 610000,China;Department of Anesthesiology,Western Theater Command General Hospital of Chinese People's Liberation Army,Chengdu 610000,China;Department of Anesthesiology,West China Chunxi Hospital,Sichuan University,Chengdu 610000,China)

机构地区：[1]四川省第四人民医院麻醉科,成都610000 [2]中国人民解放军西部战区总医院麻醉科,成都610000 [3]四川大学华西春熙医院麻醉科,成都610000

出　　处：《药物流行病学杂志》2025年第4期380-390,共11页Chinese Journal of Pharmacoepidemiology

摘　　要：目的探究右美托咪定对下肢手术患者坐骨神经阻滞联合股神经阻滞时罗哌卡因半数效应浓度(EC_(50))的影响。方法选取采用坐骨神经阻滞联合股神经阻滞麻醉法行下肢手术的患者,并随机分为对照组(0.9%氯化钠注射液)、D1组(0.50μg·kg^(-1)右美托咪定)、D2组(0.75μg·kg^(-1)右美托咪定)和D3组(1.00μg·kg^(-1)右美托咪定)。采用重复性测量方差分析患者术中不同时间点的应激反应、血清疼痛介质、生命体征及疼痛视觉模拟量表(VAS)评分变化。采用序贯法测定罗哌卡因EC_(50),采用Logistic回归模型分析右美托咪定剂量对罗哌卡因EC_(50)的影响。结果共纳入208例患者,每组各52例。与同组术前相比,4组患者术后、术后1 h的应激反应水平均明显降低,血清疼痛介质水平均明显升高(P<0.05);与对照组相比,D1组、D2组、D3组术后、术后1 h的应激反应和血清疼痛介质水平更趋于正常值,其中D3组最为趋近正常值(P<0.05)。4组患者的血氧饱和度和脑电双频指数在各时间点差异均无统计学意义(P>0.05);在T1、T2时点,对照组心率(HR)显著高于D2组、D3组(P<0.05);T1时点对照组平均动脉压(MAP)显著高于其他3组,T2时点对照组MAP显著高于D2组、D3组,T3时点对照组MAP显著高于D3组(P<0.05)。与术前相比,术后、术后1 h时4组患者VAS评分明显降低(P<0.05);且D3组患者VAS评分明显低于D1组、D2组(P<0.05)。重复性测量方差分析显示,时间因素对应激反应、血清疼痛介质水平、HR、MAP和VAS评分的影响随着麻醉方法不同而有所不同。对照组、D1组、D2组和D3组罗哌卡因EC_(50)分别为5.985、5.631、5.329和5.125μg·mL^(-1)。Logistic结果显示,右美托咪给药剂量是影响肢手术患者坐骨神经阻滞联合股神经阻滞时罗哌卡因EC_(50)的保护因素(P<0.05)。结论1.00μg·kg^(-1)右美托咪定能显著降低罗哌卡因EC_(50),是下肢手术患者坐骨神经阻滞联合股神经阻�Objective To investigate the effect of dexmedetomidine on the median effect concentration(EC_(50))of ropivacaine during sciatic nerve block combined with femoral nerve block in patients undergoing lower extremity surgery.Methods Patients with sciatic nerve block combined with femoral nerve block anesthesia who underwent lower extremity surgery from November 2021 to November 2023 were selected as the study objects.They were randomly divided into control group(0.9%saline),group D1(0.50μg·kg^(-1)dexmedetomidine),group D2(0.75μg·kg^(-1)dexmedetomidine)and group D3(1.00μg·kg^(-1)dexmedetomidine).The stress response,serum pain mediators,vital signs and visual analogue scale(VAS)of patients at different time points during operation were analyzed by repeated measures ANOVA.ropivacaine EC_(50)was measured by sequential method,and the relationship between dexmedetomidine dose and ropivacaine EC_(50)was analyzed by Logistic regression.Results A total of 208 patients were include and each group was 52 patients.Compared with the same group before surgery,the stress response level of the 4 groups after surgery and 1 h after surgery was significantly decreased,and the serum pain mediators level was significantly increased(P<0.05).Compared with the control group,the stress response and serum pain mediators levels in groups D1,D2 and D3 were more normal after surgery and 1 h after surgery,among them,group D3 was most close to the normal value(P<0.05).There were no significant differences in blood oxygen saturation and bifrequency index of EEG among the four groups at each time point(P>0.05).At T1 and T2,the heart rate(HR)of the control group was significantly higher than that of the group D2 and D3(P<0.05).At T1,the control group had a significantly higher mean arterial pressure(MAP)than the other three groups,at T2,the control group had a significantly higher MAP than the group D2 and D3,and at T3,the control group had a significantly higher MAP than the group D3(P<0.05).VAS scores in 4 groups were significantly lower afte

关 键 词：右美托咪定 罗哌卡因 坐骨神经阻滞 股神经阻滞 半数效应浓度 

分 类 号：R971.2[医药卫生—药品]