右美托咪定不同给药途径用于超声引导下腰丛-坐骨神经阻滞在踝关节手术的疗效观察

Observation of the therapeutic effect of different administration routes of dexmedetomidine on the ultrasound guided lumbar plexus-sciatic nerve block in the ankle surgery

目的探讨右美托咪定不同给药途径用于超声引导下腰丛-坐骨神经阻滞在踝关节手术的临床疗效。方法选取英山县人民医院2018年3月至2019年3月踝关节手术病人90例,采用随机组字表法分为三组,每组30例:罗哌卡因组(R组),右美托咪定联合罗哌卡因组(VDR组),右美托咪定混合罗哌卡因组(PDR组)。三组均使用超声引导下腰丛-坐骨神经阻滞;腰丛阻滞时,R组注射0.5%罗哌卡因20 mL,VDR组注射0.5%罗哌卡因20 mL后立即静脉注射右美托咪定0.5μg/kg,泵注30 min,PDR组注射含右美托咪定0.5μg/kg的0.5%罗哌卡因20 mL;坐骨神经阻滞时,各组分别注射相应药物10 m L。记录感觉、运动神经阻滞起效时间和持续时间,Ramsay评分评估镇静程度,麻醉效果,镇静过度及心血管不良事件的发生情况。结果三组感觉、运动神经阻滞起效时间和运动神经阻滞持续时间差异无统计学意义(P>0.05);与R组[坐骨神经(390.5±114.9)min,腰丛(458.2±196.7)min]相比,VDR组[坐骨神经(762.8±264.2)min,腰丛(863.3±304.0)min]和PDR组[坐骨神经(788.2±291.5)min,腰丛(889.0±312.2)min]感觉神经阻滞持续时间延长(F=26.596、22.988,P<0.001),感觉神经阻滞持续时间PDR组与VDR组比较,差异无统计学意义(P>0.05);与R组70.0%比较,VDR组96.7%和PDR组96.7%镇静满意率高,差异有统计学意义(P=0.012);镇静满意率PDR组与VDR组相比,差异无统计学意义(P>0.05);三组均未发生镇静过度,心血管不良事件差异无统计学意义(P>0.05)。结论右美托咪定联合罗哌卡因腰丛-坐骨神经阻滞用于踝关节手术具有良好的镇静镇痛效果,并可明显延长镇痛时间且不增加不良事件风险。

Objective To investigate the clinical efficacy of different administration routes of dexmedetomidine on ultrasound-guided lumbar plexus-sciatic nerve block in ankle surgery.Methods Ninety patients with ankle joint surgery in Yingshan County People’s Hospital from March 2018 to March 2019 were selected and assigned into three groups according to the random number table method including ropivacaine group(R group),ropivacaine combined with intravenous dexmedetomidine group(VDR group),dexmedetomidine combined with ropivacaine group(PDR group),with 30 cases in each group.Ultrasound-guided lumbar plexus-sciatic nerve block was used in all patients.In lumbar plexus block,0.5% ropivacaine 20 m L was injected into R group;VDR group was treated with 0.5% ropivacaine 20 mL,and then was injected intravenously at 0.5 μg/kg and pumped for 30 min;PDR group was injected 0.5% ropivacaine 20 ml containing 0.5 μg/kg dexmedetomidine.In sciatic nerve block,10 ml of corresponding drugs were injected into each group.The onset time and duration of sensory and motor nerve block were recorded.Ramsay score was used to evaluate sedation,anesthesia effect,excessive sedation and cardiovascular adverse events.Results There were no significant differences in onset time and duration of sensory and motor nerve block among the three groups.The duration of sensory nerve block in VDR group[sciatic nerve block(762.8±264.2)min,lumbar plexus block(863.3±304.0)min]and PDR group[sciatic nerve block(788.2±291.5)min,lumbar plexus block(889.0±312.2)min]were longer than those in R group[sciatic nerve block(390.5±114.9)min,lumbar plexus block(458.2±196.7)min](F=26.596,22.988,P<0.001).There was no significant difference in the duration of sensory nerve block between VDR and PDR group(P>0.05).The satisfaction rate of sedation in VDR group(96.7%)and PDR group(96.7%)was higher than that in R group(70.0%),the difference was statistically significant(P=0.012).Moreover,there was no significant difference in sedation satisfaction rate between PDR group and VDR group(P>0.05).Thus,the sedation satisfaction of VDR group and PDR group were better than that of R group.There was no excessive sedation and no significant difference in adverse cardiovascular events among the three groups(P>0.05).Conclusion Dexmedetomidine combined with ropivacaine lumbar plexus-sciatic nerve block has good sedative and analgesic effect in ankle surgery,and can also significantly prolong the analgesic time without increasing the risk of adverse events.