不同剂量右美托咪定复合罗哌卡因用于连续股神经阻滞镇痛效果分析

Analgesic effect of different doses of dexmedetomidine combined with ropivacaine continuous femoral nerve block

目的观察不同剂量右美托咪定复合罗哌卡因对下肢手术患者进行连续股神经阻滞的镇痛效果。方法选取2018年2月至2020年2月于浙江省温州市人民医院择期做下肢手术的150例患者为研究对象,根据右美托咪定给药剂量不同将患者分为A组(0.5μg/kg右美托咪定+0.2%罗哌卡因)、B组(0.75μg/kg右美托咪定+0.2%罗哌卡因)、C组(1μg/kg右美托咪定+0.2%罗哌卡因)和D组(1.25μg/kg右美托咪定+0.2%罗哌卡因),每组各30例;另选取其中单独给予0.2%罗哌卡因的30例做下肢手术的患者为对照组。比较分析五组患者术后6h、12h、24h和48h的静息状态和躯体活动时的视觉模拟评分法(visual analogue scale,VAS)评分,记录五组患者术后追加镇痛药的例数及按压镇痛泵的例数,记录五组患者术后不良反应发生情况。结果与对照组比较,A组和B组患者术后24h、48h的静息状态及躯体活动时的VAS评分均显著降低(P<0.05),C组和D组患者术后6h、12h、24h、48h的静息状态及躯体活动时的VAS评分均显著降低(P<0.05);与A组比较,C组和D组患者术后6h、12h、24h、48h的静息状态及躯体活动时的VAS评分均显著降低(P<0.05);与B组比较,D组患者术后6h、12h、24h、48h的静息状态及躯体活动时的VAS评分均显著降低(P<0.05)。与对照组比较,A组、B组、C组和D组术后48h内追加曲马多的例数及按压镇痛泵的例数均显著减少(P<0.05);与A组比较,C组和D组术后48h内追加曲马多的例数及按压镇痛泵的例数均显著减少(P<0.05)。与对照组比较,C组和D组头晕不良反应的发生率显著升高(P<0.05)。结论1μg/kg和1.25μg/kg右美托咪定复合0.2%罗哌卡因均可以显著增强股神经阻滞效果,减轻患者疼痛程度,但发生头晕不良反应的例数增多。

Objective To observe the analgesic effects of different doses of dexmedetomidine combined with ropivacaine on continuous femoral nerve block in patients undergoing lower limb surgery.Method From February 2018 to February 2020,150 patients underwent elective lower extremity surgery in Wenzhou People’s Hospital.According to different doses of dexmedetomidine,they were divided into group A(0.5μg/kg dexmedetomidine+0.2%ropivacaine),group B(0.75μg/kg dexmedetomidine+0.2%ropivacaine),group C(1μg/kg dexmedetomidine+0.2%ropivacaine)and group D(1.25μg/kg dexmedetomidine+0.2%ropivacaine),30 cases in each group.Another 30 patients with lower limb surgery who were given 0.2%ropivacaine alone were selected as the control group.Visual analoge scale(VAS)at 6h,12h,24h and 48h after surgery were observed in the five groups.The number of cases of of adding analgesics and pressing the analgesic pump after the operation were recorded,and the occurrence of adverse reactions were recorded.Result Compared with the control group,the VAS score in resting state and physical activity at 24h and 48h after surgery in groups A and B were significantly decreased(P<0.05),while the VAS score in resting state and physical activity at 6h,12h,24h and 48h after surgery in groups C and D were significantly decreased(P<0.05).Compared with group A,the VAS score in resting state and physical activity at 6h,12h,24h and 48h after surgery in group C and group D were significantly decreased(P<0.05).Compared with group B,the VAS score in resting state and physical activity at 6h,12h,24h and 48h after surgery in group D were significantly decreased(P<0.05).Compared with the control group,the number of tramadol and the number of pressing analgesia pump within 48h after surgery in group A,group B,group C and group D were significantly decreased(P<0.05).Compared with group A,the number of tramadol and the number of pressing analgesia pump in group C and group D were significantly decreased(P<0.05).Compared with the control group,the incidence of dizziness in group C and group D was significantly increased(P<0.05).Conclusion Both 1μg/kg and 1.25μg/kg dexmedetomidine combined with 0.2%ropivacaine significantly enhanced the femoral nerve block effect,and reduce the pain level of patients,but they increased dizziness adverse reactions.