右美托咪定对老年患者膝关节单髁置换术后的镇痛影响

Analgesic effect of dexmedetomidine on elderly patients after unicompartmental knee arthroplasty

目的评价术中静脉输注小剂量右美托咪定对老年患者膝关节单髁置换术(unicompartmental knee arthro plasty,UKA)术后48 h内疼痛的影响。方法选择2018年5~12月首都医科大学宣武医院择期行UKA的老年患者70例,年龄65~75岁,美国麻醉医师协会(American Society of Anesthesiologist,ASA)分级Ⅰ~Ⅱ级,随机分为两组,每组35例。行蛛网膜下腔阻滞后,分别持续静脉泵注右美托咪定(D组)和生理盐水(C组)。术毕于超声引导下行隐神经穿刺置管并连接神经阻滞镇痛泵。比较两组术后6、12、24、48 h静息视觉模拟评分(R-VAS)、被动运动视觉模拟评分(PVAS)、Ramsay镇静评分、曲马多使用情况以及术后不良反应发生情况。结果D组术后6、12 h R-VAS及P-VAS均优于C组(P<0.05),24 h内曲马多补充镇痛率D组小于C组,差异有统计学意义(P<0.05)。术后24、48 h两组R-VAS、PVAS、Ramsay评分及不良反应的差异无统计学意义(P>0.05)。结论老年患者UKA术中静脉输注小剂量右美托咪定可减轻术后12 h内静息及被动运动疼痛,减少24 h内镇痛药补充用量。

Objective To evaluate the effect of dexmedetomidine intravenous infusion intraoperative on postoperative analgesia within 48 hours after unicompartmental knee arthroplasty(UKA)in elderly patients.Methods A total of 70 elderly patients who were 65-75 years old,ASAⅡ-Ⅱ,were randomly divided into two groups,35 cases in each group.After subarachnoid block,continuous intravenous infusion of dexmedetomidine(group D)and saline(group C)were administered.The saphenous nerve block was performed under ultrasound guidance after surgery and then connected the analgesia device.The resting visual analogue score(R-VAS),passive visual analogue score(P-VAS),Ramsay sedation score,tramadol usage and adverse reactions were compared between the two groups.Results The R-VAS and P-VAS of group D were better than group C at 6 h and 12 h(P<0.05),and the supplemental rate of tramadol in group D was lower in group C within 24 h(P<0.05).There were no statistic differences in R-VAS,P-VAS,Ramsay sedation scores and adverse events between the two groups at 24 h and 48 h after operation.Conclusions In elderly patients,dexmedetomidine intravenous infusion during UKA surgery may reduce pain in 12 h after operation and the dosage of analgesic supplement in 24 h.