硫酸镁联合罗哌卡因股神经阻滞对膝关节韧带修复术患者下肢止血带反应的疗效观察

Effect of magnesium sulfate mixed ropivacaine femoral nerve block on lower extremity tourniquet reaction in the patients with knee ligament repair

目的:探讨硫酸镁联合罗哌卡因股神经阻滞对膝关节韧带修复术下肢止血带反应的疗效。方法:选择2016年2月至2018年2月于本院拟行关节镜下膝关节韧带修复术的患者83例作为本研究对象,随机分为试验组(n=42)和对照组(n=41);两组均在超声引导下实施患侧股神经阻滞麻醉,试验组给予0.375%罗哌卡因15mL(含有0.75g硫酸镁)混合液注射,对照组给予0.375%罗哌卡因15mL注射,两组麻醉成功后均于大腿中上1/3处缚扎自动充气止血带。比较两组感觉和运动阻滞起效时间、持续时间和镇痛时间、不同时间点血流动力学和血清丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)的变化,记录止血带反应发生率和药物不良反应。结果:与对照组相比,试验组感觉阻滞和运动阻滞起效时间缩短,持续时间、镇痛时间延长(P<0.05);两组不同时间点收缩压(SBP)、舒张压(DBP)、心率(HR)比较,差异均具有统计学意义(P<0.05);试验组T7、T8血清MDA、TNF-α高于对照组(P<0.05);两组止血带反应发生率分别为7.14%(3/42)和24.39%(10/41),差异具有统计学意义(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论:在膝关节韧带修复术中应用硫酸镁混合罗哌卡因股神经阻滞效果显著,可有效维持血流动力学稳定、延长阻滞效果,缓解氧化应激和炎症反应,减少止血带反应,安全性高,值得应用推广。

AIM : To study the effect of magnesium sulfate mixed ropivacaine femoral nerve block on lower extremity tourniquet reaction in the patients with knee ligament repair. METHODS :A total of 83 patients of underwent arthroscopic knee ligament repair who received therapy from February 2016 to February 2018 in our hospital were selected as research objects, they were randomly divided into treatment group ( n =42) and control group ( n =41), the two groups were operated under the guidance of ultrasound machine, the treatment group was given 0.375% ropivacaine 15 mL (containing Magnesium Sulfate 0.75 g) mixed injection, and the control group was given 0.375% ropivacaine 15 mL injection, after successful anesthesia, the tourniquet was attached to the root of the thigh and then inflated. The onset time, duration and analgesic time of sensory and motor block, the changes of the hemodynamics, serum malondialdehyde (MDA) and tumor necrosis factor-alpha (TNF-α) at different time points were compared between the two groups, and the incidence of tourniquet reaction and adverse drug reactions were recorded. RESULTS :Compared with the control group, the onset time of sensory block and motor block in the treatment group was shorten, and the duration and analgesic time were extend ( P < 0.05 );there were significant differences in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) between the two groups at different time points( P < 0.05 );the serum MDA and TNF-α at T7 and T8 in the treatment group were higher than those in the control group( P < 0.05 );the tourniquet reactions were 7.14%(3/42)and 24.39%(10/41) respectively in the two groups, the difference was statistically significant( P < 0.05 );there was no significant difference in the incidence of adverse reactions between the two groups( P > 0.05 ). CONCLUSION :Magnesium sulfate mixed ropivacaine femoral nerve block is well for lower extremity surgery,which can effectively maintain hemodynamic stability, prolong block effect, relieve oxidative stress and inflammatory reaction, reduce tourniquet reaction, and has high safety. It is worthy of application and promotion.