罗哌卡因复合右美托咪定用于股神经阻滞对TKA患者的影响

Effect of Ropivacaine Combined with Dexmedetomidine for Femoral Nerve Block in Patients with TKA

目的探究超声引导下右美托咪定复合罗哌卡因的股神经阻滞对行人工全膝关节置换术(total knee arthroplasty,TKA)的患者神经递质及炎症反应的影响。方法选取行TKA术的90例患者,按照随机数字表法分为UR组和DR组,各45例。UR组患者超声引导下行罗哌卡因麻醉,DR组超声引导下行右美托咪定复合罗哌卡因麻醉。取术前(T0)、术后24 h(T1)、术后48 h(T2)血清标本检测神经递质及炎症因子,并采用简易精神状态评价量表(MMSE)评估2组患者T2时点认知功能障碍(POCD)发生情况。结果2组患者神经递质多巴胺(DA)、5-羟色胺(5-HT)、乙酰胆碱(Ach)、γ-氨基丁酸(GABA)、β-内啡肽(β-EP)及炎症因子白细胞介素-6(IL-6)、白细胞介素-1β(IL^(-1)β)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)均以时间因素以及时间因素和分组的交互作用比较,差异有统计学意义(P<0.05)。组内比较,同T0时点比较,T1、T2时点2组DA、5-HT、β-EP及IL-6、IL^(-1)β、TNF-α、hs-CRP均升高,而Ach、GABA降低,差异有统计学意义(P<0.05);组间比较,T0时点2组神经递质DA、5-HT、Ach、GABA、β-EP及炎症因子IL-6、IL^(-1)β、TNF-α、hs-CRP比较,差异无统计学意义(P>0.05);T1、T2时点DR组DA、β-EP及IL-6、IL^(-1)β、TNF-α、hs-CRP低于UR组,而Ach、GABA高于UR组,差异有统计学意义(P<0.05)。DR组POCD发生率17.78%,低于UR组37.78%,差异有统计学意义(P<0.05)。结论右美托咪定复合罗哌卡因用于超声引导下的股神经阻滞可减轻TKA术患者神经功能损害及炎症反应,并减少术后POCD发生率。

Objective To investigate the effects of ultrasound-guided Dex combined with ropivacaine on the neurotransmitter and inflammatory response in patients undergoing TKA.Methods A total of 90 patients who underwent TKA were divided into the UR group and the DR group by random number table method,with 45 patients in each group.The UR group underwent ultrasound-guided ropivacaine anesthesia,while the DR group underwent ultrasound-guided dexmedetomidine combined with ropivacaine anesthesia.Serum samples of T0,T1,and T2 were TKA to detect neurotransmitters and inflammatory factors,and MMSE was used to evaluate POCD occurrence at time T2 in both groups.Results The neurotransmitters DA,5-HT,Ach,GABA,β-EP and inflammatory factors IL-6,IL^(-1)β,TNF-αand hs-CRP in the 2 groups were statistically significant by time factor and the interaction of time factor and grouping(P<0.05).Multiple comparison results showed that DA,5-HT,β-EP and inflammatory factors IL-6,IL^(-1)β,TNF-αand hs-CRP were significantly increased(P<0.05),while Ach and GABA were significantly decreased(P<0.05),in T1 and T2 groups compared with T0.The differences of DA,5-HT,Ach,GABA,β-EP and inflammatory cytokines IL-6,IL^(-1)β,TNF-αand hs-CRP between the two groups at time T0 were not statistically significant(P>0.05).The DA,β-EP and IL-6,IL^(-1)β,TNF-αand hs-CRP in the T1 and T2 DR group were significantly lower than those in UR group(P<0.05),while Ach and GABA were significantly higher than those in UR group(P<0.05).In addition,POCD incidence was 17.78%in the DR group,lower than 37.78%in the UR group,the difference was statistically significant(P<0.05).Conclusion Dexcombined with ropivacaine for ultrasound-guided femoral nerve block can reduce the neurological impairment and inflammatory response in TKA patients,and reduce the incidence of postoperative POCD.