不同浓度右美托咪定联合罗哌卡因连续腰丛神经阻滞的镇痛效果

Analgesic effect of dexmedetomidine at different concentrations combined with ropivacaine for continuous lumbar plexus block

目的探讨老年患者髋关节置换术后使用不同浓度右美托咪定联合罗哌卡因连续腰丛神经阻滞的镇痛效果。方法前瞻性选取于我院行髋关节置换术的老年患者177例,采用随机数字表法将其分为低浓度组、中浓度组、高浓度组,每组59例。术后均开启连续腰丛神经阻滞镇痛泵,低浓度组0.5μg/mL右美托咪定+0.1%罗哌卡因,中浓度组0.75μg/mL右美托咪定+0.1%罗哌卡因,高浓度组1.0μg/mL右美托咪定+0.1%罗哌卡因。比较3组患者麻醉用药量以及不良反应情况。于术后6 h、12 h、24 h、48 h比较3组患者视觉模拟量表(VAS)评分、Ramsay镇静(RSS)评分、髋关节活动度、患肢肌力评分以及血液流变性指标。结果低、中、高浓度3组中,罗哌卡因用量、吗啡用量以及患者自控镇痛(PCA)按压次数依次减少,任意2组间比较差异均有统计学意义(P<0.05)。RSS评分在组内不同时间点、组间相同时间点比较差异均无统计学意义(P>0.05)。术后6 h、12 h、24 h、48 h,低、中、高浓度3组间VAS评分、血液流变性指标水平均依次降低,患肢肌力评分、髋关节最大屈曲度以及最大外展活动度均依次增加,任意2组间比较差异均有统计学意义(P<0.05)。3组患者不良反应总发生率比较差异均无统计学意义(P>0.05)。结论1.0μg/mL右美托咪定联合0.1%罗哌卡因连续腰丛神经阻滞对老年患者髋关节置换术后的镇痛效果较好,可促进患肢肌力和髋关节功能的恢复,明显改善血液流变性指标水平,降低血液黏度,且不会增加不良反应的发生率。

Objective To investigate the analgesic effect of dexmedetomidine at different concentrations combined with ropivacaine for continuous lumbar plexus block after hip arthroplasty in elderly patients.Methods A total of 177 elderly patients undergoing hip arthroplasty in our hospital were prospectively selected and divided into the low concentration group,the medium concentration group and the high concentration group by random number table method,with 59 cases in each group.The analgesic pump of continuous lumbar plexus block was turned on after operation.Patients in the low concentration group received 0.5μg/mL dexmedetomidine+0.1%ropivacaine;those in the medium concentration group received 0.75μg/mL dexmedetomidine+0.1%ropivacaine;and those in the high concentration group received 1.0μg/mL dexmedetomidine+0.1%ropivacaine.The consumption volume of anesthetic drugs and adverse reactions were compared among the three groups.The visual analogue scale(VAS)score,Ramsay sedation scale(RSS)score,hip joint motion,muscle strength score of the affected limb and hemorheological indexes were compared at 6 hours,12 hours,24 hours and 48 hours after operation.Results Consumption volumes of ropivacaine and morphine and patient controlled analgesia(PCA)pressing times were reduced respectively in the low,medium and high concentration group,and the differences were statistically significant between any two groups(P<0.05).There was no statistically significant difference in RSS score at different time points within the same group or at the same time points between any two groups(P>0.05).VAS score and hemorheology indexes were reduced respectively,while muscle strength score of the affected limb,the maximum flexural degree of hip joints and the maximum abduction range of the motion were increased respectively in the low,medium and high concentration group at 6 hours,12 hours,24 hours and 48 hours after operation,and the differences between any two groups were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions among the three groups(P>0.05).ConclusionDexmedetomidine at the concentration of 1.0μg/mL combined with 0.1%ropivacaine for continuous lumbar plexus block has better analgesic effect in elderly patients after hip arthroplasty,which can promote the recovery of muscle strength and hip joint function of the affected limb,significantly improve the level of hemorheology indexes,reduce blood viscosity,and does not increase the incidence of adverse reactions.