右美托咪定联合甲磺酸罗哌卡因肋间神经阻滞改善多发性肋骨骨折患者疼痛、睡眠的研究

Study of dexmedetomidine combined with ropivacaine intercostal block on pain and sleep in patients with multiple ribsfracture

目的研究右美托咪定联合甲磺酸罗哌卡因行肋间神经旁注射进行神经阻滞对多发性肋骨骨折患者疼痛、睡眠的影响。方法选取2017年9月至2018年9月浙江大学医学院附属第二医院兰溪分院收治的178例多发性肋骨骨折患者,按随机数字表法分为对照组(甲磺酸罗哌卡因)88例和试验组(右美托咪定联合甲磺酸罗哌卡因)90例,入院第二天在超声引导下行肋间神经阻滞。观察、比较两组阻滞后各时间点的静息痛、咳嗽痛、夜间疼痛等评分,以及阻滞后3天睡眠情况等。结果在4~7根肋骨骨折患者中,16 h内试验组中静息疼痛评分均明显低于对照组[(1.3 ± 0.6)分比(1.7 ± 0.7)分、(2.1 ± 0.4)分比(2.2 ± 0.6)分、(2.2 ± 0.3)分比(2.3 ± 0.3)分];而在咳嗽疼痛评分中,试验组在24 h内疼痛评分明显优于对照组[(1.6 ± 0.8)分比(2.5 ± 0.9)分、(3.0 ± 0.7)分比(3.3 ± 0.8)分、(3.3 ± 0.7)分比(4.0 ± 0.9)分、(4.9 ± 1.0)分比(5.4 ± 1.0)分],差异均有统计学意义(P < 0.05)。在大于7根肋骨骨折患者中,在12 h之内,无论是静息疼痛评分还是咳嗽疼痛评分比较,试验组均明显优于对照组,差异有统计学意义(P < 0.05)。阻滞后第一天、第二天,试验组中失眠评分明显低于对照组[(2.5 ± 0.7)分比(4.2 ± 1.6)分、(2.8 ± 0.8)分比(4.5 ± 1.5)分],差异有统计学意义(χ2值分别为7.347、7.989,P < 0.05);两组均未发生不良反应。结论对于多发性肋骨骨折患者,应用右美托咪定联合甲磺酸罗哌卡因行肋间神经旁注射,能改善镇痛效果,延长镇痛时间,改善睡眠质量。

Objective To study the effects of dexmedetomidine combined with ropivacaine for intercostal nerve block on pain and sleep in patients with multiple ribs fracture. Methods One hundred and seventy-eight patients with multiple ribs fracture were divided into two groups according to the random digits table method: control group (ropivacaine, 88 cases) and experimental group (dexmedetomidine combined with ropivacaine, 90cases). On the second day after admission, the patient underwent intercostal nerve block guided by ultrasound. Pain score of resting pain, cough pain and night pain at each time point and the sleep condition was compared after 3 days. Results In 4-7 ribs fracture patients, the resting pain score in the experimental group was significantly lower than that in the control group within 16 hours:(1.3 ± 0.6)scores vs.(1.7 ± 0.7) scores,(2.1 ± 0.4) scores vs.(2.2 ± 0.6) scores,(2.2 ± 0.3) scores vs.(2.3 ± 0.3)scores;while in the cough pain score, the experimental group was significantly better than the control group within 24 hours:(1.6 ± 0.8) scores vs.(2.5 ± 0.9) scores,(3.0 ± 0.7) scores vs.(3.3 ± 0.8) scores,(3.3 ± 0.7) scores vs.(4.0 ± 0.9) scores,(4.9 ± 1.0) scores vs.(5.4 ± 1.0) scores. The differences were statistically significant (P < 0.05). In patients with more than 7 ribs fractures, the resting pain scoreand cough pain score, the experimental group were significantly better than those in the control group within 12 hours (P < 0.05). On the first day and the second day after the block, the insomnia scores in the experimental group were significantly lower than those of the control group:(2.5 ± 0.7) scores vs.(4.2 ± 1.6) scores,(2.8 ± 0.8) scores vs.(4.5 ± 1.5) scores. The difference was statistically significant (χ……2=7.374, 7.989, P < 0.05). Conclusions For patients with multiple ribs fracture, the use of dexmedetomidine combined with ropivacaine for intercostal nerve block can improve the analgesic effect, prolong the analgesic time, and improve sleep quality.