右美托咪定与瑞芬太尼对神经阻滞麻醉下膝关节镜手术中止血带痛的效果比较

目的比较右美托咪定和瑞芬太尼用于神经阻滞麻醉下膝关节镜手术中止血带痛的效果。方法90例行择期行膝关节镜手术的患者随机分为右美托咪定组（D组）、瑞芬太尼组（R组）和对照组（C组），每组各30例。术前10min开始分别泵注相应药物。记录止血带充气前准备抬高患肢时（TO）、充气即刻（T1）、充气30min（T2）、充气60min（T3），以及在使用止血带过程中最高的收缩压（SBP）、舒张压（DBP）、心率（H1K）值。记录TO—T3时点的疼痛视觉模拟评分（VAS），记录泵注药物期间呼吸抑制的发生次数。结果D组和R组患者在T1，T2，T3时点以及止血带使用过程中最高的SBP、DBP、HI（均低于C组（P〈0．05）。D组和R组患者在T1，T2，T3时点的VAS均低于C组（P〈0．05）。呼吸抑制的发生率R组患者较D组和C组高（P〈005）。结论右美托咪定和瑞芬太尼均可有效缓解膝关节镜手术中的止血带痛，相较于瑞芬太尼，右美托咪定呼吸抑制发生率更低，更为安全。

Objective To compare the effects on tourniquet pain during knee arthroscopic between dexmedetomidine and remifentanih Methods Ninety patients undergoing selective knee arthroscopic were allocated and randomly divided into group dexmedetomidine （ Group D ） , remifentanil （ Group R ） and controls （ Group C ） . The values of systolic blood pressure （ SBP ） , diastolic blood pressure （ DBP ） and heart rate （ HIK ） and visual analog scale （ VAS ） were obtained before tourniquets were inflated （ TO ） , at the time of inflation （ TI ） , 30rain after inflation （ T2 ） and 60rain after inflation （ T3 ） , respectively. The maximal values of SBP, DBP and HR during the period of tourniquet inflated, incidences of respiratory depression were also recorded. Results The values of SBP, DBP, HR, and VAS at T1, T2, T3, and the highest SBP, DBP, HR values during tourniquets inflated were significantly lower in group R and group D than those in group C （ P〈0.05 ） . The incidences of respiratory depression were lower in group D than those in group P, （ P〈0.05 ） . Conclusion Both dexmedetomidine and remifentanil attenuate tourniquet pain, whereas dexmedetomidine, compared with remifentanil, has less effect on respiration, and turn out to be more reliable.