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| 右美托咪定复合不同浓度罗哌卡因用于连续股神经阻滞的镇痛效果 |
| Analgesic effect of dexmedetomidine combined with different concentrations of ropivacaine for continuous femoral nerve block |
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| DOI：10.12089/jca.2019.03.017 |
| 中文关键词: 右美托咪定 罗哌卡因 连续股神经阻滞 术后镇痛 全膝关节置换术 |
| 英文关键词: Dexmedetomidine Ropivacaine Continuous femoral nerve block Postoperative analgesia Total knee arthroplasty |
| 基金项目: |
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| 摘要点击次数: 3510 |
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| 中文摘要: |
目的 观察右美托咪定复合不同浓度罗哌卡因对全膝关节置换术（TKA）患者连续股神经阻滞（CFNB）镇痛效果和肌力的影响。
方法 选择2016年6月至12月期间本院全膝关节置换术患者90例，男16例，女74例，年龄40~80岁，BMI 25.7~31.2 kg/m2，ASA I 或II 级，随机分为三组：0.2 % 罗哌卡因组（R0.2组）、0.15 % 罗哌卡因组（R0.15组）和0.1% 罗哌卡因组（R0.1组），每组30例。R0.2组、R0.15组和R0.1组分别以0.2%罗哌卡因、0.15%罗哌卡因和0.1%罗哌卡因行术后CFNB自控镇痛（PCA），上述罗哌卡因均复合右美托咪定400 μg。分别记录术后4、8、12、24、48 h 静息和活动时VAS评分、术后48 h内罗哌卡因总量、PCA总按压次数和使用吗啡情况，记录术后12、24、48 h肌力分级情况，术后1、2、3 d 符合“四合一标准”出院情况，记录血肿、渗液、跌倒、低血压、心动过缓、恶心呕吐、过度镇静等不良反应发生情况。
结果 术后4、8、12、24 h R0.2组和R0.15组活动时VAS评分明显低于R0.1组（P<0.05）。R0.2组和R0.15组罗哌卡因总量明显低于R0.1组（P<0.05），PCA总按压次数明显少于R0.1组（P<0.05）。术后12、24 h R0.2组和R0.15组肌力明显低于R0.1组（P<0.05），且R0.2组明显低于R0.15组（P<0.05）。术后2 d R0.2组和R0.15组出院率明显低于R0.1组（P<0.05）。三组患者血肿、渗液、跌倒、低血压、心动过缓、恶心呕吐、过度镇静等不良反应发生情况差异无统计学意义。三组患者均未出现置管部位感染、神经损伤、局麻药中毒等不良反应。
结论 右美托咪定400 μg复合 0.15 % 罗哌卡因连续股神经阻滞，镇痛作用完善，对股四头肌肌力影响轻微，有利于全膝关节置换术患者术后的早期康复锻炼。 |
| 英文摘要: |
Objective To investigate the effects of combine dexmedetomidine and different concentrations of ropivacaine for continuous femoral nerve block (CFNB) on postoperative pain and muscle strength in patients undergoing total knee arthroplasty (TKA).
Methods Ninety patients from June to December 2016, undergoing TKA，16 males and 74 females, aged 40 - 80 years, BMI 25.7-31.2 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into 3 groups（n=30 each group）：0.2 % ropivacaine group （group R0.2），0.15 % ropivacaine group（group R0.15） and 0.1 % ropivacaine group （group R0.1），group R0.2, group R0.15 and group R0.1 all combined with 400 μg dexmedetomidine. VAS score were recorded at the time of 4,8,12,24,48 h after operation during rest and rehabilitation on exercise. The total dosage of ropivacaine, the total press times of PCA, the dosage of morphine were recorded within 48 h after operation. The muscle strength grades at the time of 12,24,48 h after operation， and the proportion of patients discharged according to the “ time to attain four criteria” at 1, 2, 3 days after operation, the side-effects such as hematoma，exudation，falls, hypotension, bradycardia, nausea， vomiting, and excessive sedation were recorded.
Results Compared with group R0.1, the VAS score during rehabilitation exercise of group R0.2 and R0.15 were lower at 4, 8, 12, 24 h after operation (P<0.05). The total dosage of ropivacaine and the press times of PCA of group R0.2 and R0.15 were lower than those of group R0.1 (P<0.05). The average rank of muscle strength in group R0.2 and group R0.15 was significantly lower than in R0.1 group (P<0.05), and that in R0.2 group was significantly lower than in group R0.15 (P<0.05). Compared with group R0.1, the proportion of patients discharged during 2 days after operation was lower in group R0.2 and R0.15(P<0.05). The occurrence of adverse effects had no difference in each group.
Conclusion Dexmedetomidine can reduce the analgesic concentration of ropivacaine. The mixture of 0.15 % ropivacaine and 400 μg dexmedetomidine for CPNB provides satisfactory analgesic effect, has slight influence on quadriceps muscle strength, and is benefit for the early postoperative rehabilitation exercise of patientsundergoing TKA. |
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