右美托咪定复合罗哌卡因对膝关节置换术后镇痛镇静效果、睡眠质量及应激反应的影响

Effects of Dexmedetomidine Combined with Ropivacaine on Analgesia,Sedation,Sleep Quality and Stress Response after Knee Arthroplasty

目的:探讨右美托咪定复合罗哌卡因对膝关节置换术后的临床效果。方法:选取2015年2月~2018年12月期间在武警陕西省总队医院择期行膝关节置换术患者103例,根据随机数字表将患者分成对照组(n=51)和研究组(n=52),对照组股神经阻滞时给予罗哌卡因,研究组在对照组基础上联合右美托咪定。比较两组患者镇痛镇静效果、睡眠质量、应激反应以及不良反应。结果:研究组术后12 h、术后24 h、术后48 h视觉模拟评分(VAS)低于对照组(P<0.05),Ramsay镇静评分则高于对照组(P<0.05)。研究组术后24 h、术后48 h阿森斯失眠量表(AIS)评分均低于术前,且呈先降低后升高趋势(P<0.05)。研究组术后24 h、术后48 h AIS评分低于对照组(P<0.05)。两组患者手术开始即刻、术毕的去甲肾上腺素(NE)、肾上腺素(E)水平均上升,且呈先升高后降低趋势(P<0.05);研究组手术开始即刻、术毕的NE、E水平低于对照组(P<0.05)。两组不良反应发生率对比无统计学差异(P>0.05)。结论:右美托咪定复合罗哌卡因方案应用于膝关节置换术,镇痛镇静效果确切,可减轻术中应激反应,有效改善睡眠质量,且不增加不良反应发生率,临床应用价值较高。

Objective:To explore the clinical effects of dexmedetomidine combined with ropivacaine on knee arthroplasty.Methods:103 patients with knee arthroplasty in Shaanxi Provincial Armed Police Corps Hospital from February 2015 to December 2018 were selected,and they were divided into control group(n=51)and study group(n=52)according to the random number table.Ropivacaine was given to the control group when femoral nerve was blocked.The study group was combined with dexmedetomidine on the basis of the control group.The analgesic and sedative effects,sleep quality,stress reaction and adverse reactions were compared between the two groups.Results:Visual analogue score(VAS)of the study group were lower than that of the control group at 12 h,24 h and 48 h after operation(P<0.05),while Ramsay sedation score was higher than that of the control group(P<0.05).The athens insomnia score(AIS)of the study group at 24 h after operation and 48 h after operation were lower than that of before operation,and it decreased first and then increased(P<0.05).AIS score of study group at 24 h and 48 h after operation were lower than that of control group(P<0.05).The levels of norepinephrine(NE)and epinephrine(E)increased immediately at immediately after the operation began and after operation in both groups,the trend of increase first and then decrease(P<0.05).The levels of NE and E in the study group at immediately after the operation began and after operation were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Dexmedetomidine combined with ropivacaine has a definite analgesic and sedative effect after knee arthroplasty.It can alleviate intraoperative stress reaction and improve sleep quality effectively without increasing the incidence of adverse reactions.Which has a high clinical value.