长效酰胺类局麻药同剂量下浓度差异对行骨折内固定物取出患者心率变异性参数水平及并发症的影响

Influence of concentration differences of long-acting amide local anesthetics at the same dosage on the HRV parameter level and complications of patients with fracture internal fixation removal

目的探讨长效酰胺类局麻药同剂量下浓度差异对行骨折内固定物取出患者心率变异性(HRV)参数水平及并发症的影响。方法研究对象选取我院2014年7月至2016年7月收治的行下肢骨折内固定物取出患者,共150例,以随机数字表法分为A组(50例)、B组(50例)及C组(50例),分别采用0. 375%、0. 5%、0. 75%罗哌卡因同剂量注射行神经阻滞麻醉,比较三组患者麻醉前后低功频率(LF)、高功频率(HF)、LF/HF、连续24 h内正常RR间期标准差(SDNN)、相邻正常RR间期标准差(RMSSD)、相邻RR间期差值超过50 ms的百分比(PNN50%)水平,镇痛维持时间、运动恢复时间、LF值恢复至注药前水平时间及并发症发生率等。结果C组患者LF、HF、SDNN及PNN50%水平均显著低于麻醉前、A组及B组(P <0. 05);三组患者麻醉前后LF/HF和RMSSD水平比较差异无统计学意义(P> 0. 05);三组患者镇痛维持时间、运动恢复时间及LF值恢复至注药前水平时间比较差异无统计学意义(P> 0. 05);三组患者并发症发生率比较差异无统计学意义(P> 0. 05)。结论长效酰胺类局麻药同剂量下浓度增加可导致行骨折内固定物取出患者HRV参数波动幅度,且未改善总体镇痛效果和并发症发生风险。

Objective To investigate the influence of concentration differences of long-acting amide local an-esthetics at the same dosage on the HRV parameter level and complications of patients with fracture internal fixation re-moval. Methods Totally 150 patients with fracture internal fixation removal of lower extremity were chosen in the pe-riod from July 2014 to July 2016 in our hospital and they were randomly divided into 3 groups, including group A （ n = 50） with 0. 375% of ropivacaine, group B （ n =50） with 0. 5% of ropivacaine and group C （ n =50） with 0. 75% of ropivacaine. The levels of LF,HF,LR/HF,SDNN,RMSSD and PNN50% before and after anesthesia,the analgesia ma-intenance time, the recovery time of motor, the recovery time of LF,and the incidence of complications among the 3 groups were compared. Results After treatment,the levels of LF,HF,SDNN and PNN50% of group C were signifi-cantly lower than those before anesthesia and those in group A and group B （ P〈0.05 ） . There was no significant difference in the levels of LF/HF and RMSSD among the three groups （ P 〉0.05）. There was no significant difference in the analgesia maintenance time and the recovery time of motor and LF among the three groups （ P 〉0.05）. There was no significant difference in the incidence of complications among the three groups （ P 〉0.05）. Conclusion The increased concentration of long-acting amide local anesthetics at the same dosage for patients with fracture internal fixa-tion removal can lead to higher HRV parameter fluctuations, and it does not improve the overall analgesic effect and complication risk.