右美托咪定用于膝关节镜术后多模式镇痛的临床观察

The efficacy of dexmedetomidine for multimodal analgesia on postoperative analgesia after arthroscopic knee surgery

目的 观察右美托咪定（dexmedetomidine,Dex）用于膝关节镜术后多模式镇痛的效果.方法 90例美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级需行关节镜诊治术患者,按随机数字表法分为3组（每组30例）：A组患者关节腔内注入含1μg/kgDex的0.25％罗哌卡因混合溶液20 ml,静脉给予生理盐水20 ml;B组患者关节腔内注入0.25％罗哌卡因20 ml,静脉给予含1 μg/kg Dex的溶液20 ml;C组关节腔内注入0.25％罗哌卡因20 ml,静脉给予生理盐水20 ml.比较3组患者术后1、2、4、8、12、20、24 h的视觉模拟评分（visual analogue scale,VAS）、Ramsay镇静评分、镇痛持续时间、术后24 h芬太尼用量及副作用发生率.结果 患者术后A组,B组1、2、4、8h的VAS静息及运动状态评分明显低于C组（P＜0.05）;但术后12h后,3组患者VAS评分差异无统计学意义;B组1、2h的Ramsay评分明显高于A组、C组（P＜0.05）,A组2、4h的Ramsay评分高于C组分（P＜0.05）,但术后8h以后,A组、B组、C组3组患者Ramsay评分差异无统计学意义（P＞0.05）,镇痛持续时间A组（650±127） min较B组（452±86） min、C组（390±74）m in明显延长,B组较C组延长（P＜0.05）;术后24 h芬太尼用量A组（22±6）μg较B组（92±10） μg、C组（146±21） μg明显减少,B组较C组减少（P＜0.05）;3组心动过缓发生率B组显著高于A组、C组（P＜0.05）.结论 在膝关节镜术后多模式镇痛方案中,关节腔内注射Dex与罗哌卡因混合液可显著减轻关节镜术后疼痛,减少术后阿片类药物的使用,并延长镇痛持续时间.

Objective To assess the efficacy of dexmedetomidine （Dex） for multimodal analgesia after arthroscopic knee surgery.Methods Ninety patients undergoing arthroscopic knee surgery were randomly assigned to three groups （n=30）：group A received iv.normal saline 20 ml and intra-articular Dex 1 μg/kg and 0.25% ropivacaine 20 ml,group B received iv.Dex μg/kg and intra-articular 0.25% ropivacaine 20 ml,group C received iv.normal saline 20 ml and intra-articular 0.25% ropivacaine 20 ml.The visual analogue scales （VAS） and sedation scores after operation （1,2,4,8,12,20,24 h）,duration of analgesia,total postoperative analgesic used during the first 24 h and adverse reactions were evaluated.Results Compared with group C,the VAS scores was significantly reduced at 1,2,4,8 h after operation in group A,and at 1,2 h in group B after operation （P〈0.05）,but it did not significantly differ among three groups at 12 h after operation.Compared with group B,the Ramsay score was lower significantly at 1 h and 2 h after operation in group A and group C.Ramsay scores at 2 h and 4 h after operation were higher in group A than these in group C （P〈0.05）,but they did not significantly differ among three groups at 8,12,20,24,8 h after operation.Compared with group C,duration of analgesia was much longer （390±74） min vs （650±127） min and （452±86） min,total consumption of fentanyl was less（146±21） μg vs （22±6） μg and （92±10） μg in groups A and B（P〈0.01）.The incidence of bradycardia was higher in group B than in group A or C （P〈0.01）.Conclusions In the scheme of multimodal analgesia for arthroscopic knee surgery,intra-articular injection of Dex and ropivacaine can significantly relieve postoperative pain,reduce the use of opioids and prolong the duration of analgesia.