右美托咪定对罗哌卡因超声引导连续股神经阻滞镇痛效果的影响

发布时间：2018-10-23 19:00

【摘要】：目的探讨右美托咪定(DEX)对罗哌卡因超声引导连续股神经阻滞镇痛效果的影响。方法择期行单侧全膝关节置换术的病人40例,采用硬腰联合麻醉,术后进行连续股神经阻滞镇痛,随机分为DEX+罗哌卡因组(D组)和罗哌卡因组(R组)。两组患者均在超声引导下股神经穿刺置管,接PCA电子泵经导管持续给药,D组泵内药物配方:0.125%罗哌卡因240 ml+DEX 4μg/kg,R组泵内药物配方:0.125%罗哌卡因240 ml。两组均给予负荷剂量20 ml(泵内抽取),然后按背景输注剂量4 ml/h,PCA每次1 ml,锁定时间15 min,持续镇痛48 h。记录病人术后4、8、12、24、48 h静息状态和持续被动运动时的视觉模拟评分(VAS)疼痛评分、肌力分级、Rasmay镇静评分、患肢膝关节主动屈曲的角度、不良反应、额外镇痛等情况。结果术后8、12、24 h D组患者静息状态下VAS评分(RVAS)和持续被动运动VAS评分(PVAS)明显低于R组(P0.05)。术后4、8、12 h D组患者Rasmay镇静评分明显高于R组(P0.05)。术后12、24、48 h D组患者主动关节屈曲角度均大于R组(P0.05)。R组术后患者术后不良反应的发生率明显大于D组(P0.05)。结论 DEX复合罗哌卡因超声引导连续股神经阻滞可以产生有效的镇痛、镇静效果,减少术后并发症的发生。
[Abstract]:Objective to investigate the analgesic effect of dexmetomidine (DEX) on ropivacaine guided continuous femoral nerve block. Methods Forty patients undergoing unilateral total knee arthroplasty were randomly divided into DEX ropivacaine group (group D) and ropivacaine group (group R). In both groups, the femoral nerve puncture tube was inserted under the guidance of ultrasound and the PCA electron pump was continuously administered through the catheter. Group D: 0.125% ropivacaine 240 ml DEX / kg / kg group: 0.125% ropivacaine 240 渭 g / kg / kg group: 0.125% ropivacaine 240 ml. Both groups were given a loading dose of 20 ml (pump extraction) and then continued analgesia for 48 hours according to the background infusion dose of 4 ml/h,PCA, 1 ml, locking time, 15 min,. The visual analogue score (VAS), muscle strength grade, Rasmay sedative score, the angle of active flexion, adverse reaction and extra analgesia were recorded. Results the VAS score (RVAS) and VAS score (PVAS) of group D were significantly lower than those of group R (P 0.05). The Rasmay sedation score of group D was significantly higher than that of group R (P 0.05). The incidence of postoperative adverse reactions in group D was significantly higher than that in group D (P0.05), and the incidence of postoperative adverse reactions in group D was significantly higher than that in group R (P0.05). Conclusion continuous femoral nerve block guided by DEX combined with ropivacaine can produce effective analgesia, sedation and reduce postoperative complications.
【作者单位】：胜利油田中心医院麻醉科;东营市东营区人民医院麻醉科;
【分类号】：R614

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