关节腔内注射右美托咪定联合罗哌卡因对肩关节镜手术患者术后镇痛的影响

Effect of intra-articular injection of dexmedetomidine combined with ropivacaine on postoperative analgesia in patients undergoing shoulder arthroscopy

目的探讨关节腔内注射右美托咪定联合罗哌卡因对肩关节镜手术患者术后镇痛的影响。方法选取2018年12月—2020年1月沈阳市某医院行肩关节镜手术的患者66例为研究对象,按随机数字表法分为对照组及观察组,各33例。方法对照组患者术后给予关节腔内注射罗哌卡因镇痛治疗,观察组患者在对照组治疗基础上加用右美托咪定镇痛治疗。比较2组患者术后首次镇痛时间、术后24 h镇痛药物总用量及临床疗效,比较2组患者术前及术后2周时美国加州大学(UCLA)肩关节评分、视觉模拟量表(VAS)评分。结果对照组患者治疗总有效例数为25例,治疗总有效率为75.8%,观察组患者治疗总有效例数为31例,治疗总有效率为93.9%,研究组患者治疗总有效率明显高于对照组,差异有统计学意义(χ^(2)=4.243,P=0.039)。术前,2组患者UCLA肩关节评分比较,差异无统计学意义(P>0.05),术后2周时,2组患者UCLA肩关节评分均明显高于术前,且观察组明显高于对照组,差异均有统计学意义(P<0.05)。术前,2组患者VAS评分比较,差异无统计学意义(P>0.05),术后2周时,2组患者VAS评分均明显低于术前,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者术后首次镇痛时间明显长于对照组,差异有统计学意义(P<0.05),术后24 h内镇痛药物总用量明显少于对照组,差异有统计学意义(P<0.05)。结论关节腔内注射右美托咪定联合罗哌卡因对肩关节镜手术患者的术后镇痛效果更佳,患者肩关节功能恢复明显,同时还可延长术后镇痛时间,降低术后对其他镇痛药物的依赖性,值得临床深入研究与应用。

Objective To investigate the effect of intra-articular injection of dexmedetomidine combined with ropivacaine on postoperative analgesia in patients undergoing shoulder joint surgery.Methods Sixty-six patients undergoing shoulder arthroscopy in a hospital in Shenyang from December 2018 to January 2020 were selected for the study.They were divided into a control group and an observation group,33 cases each,according to the random number table method.Methods Patients in the control group were treated with intra-articular injection of ropivacaine for analgesia after surgery,and patients in the observation group were treated with dexmedetomidine for analgesia on top of the control group.The time of first postoperative analgesia,the total amount of analgesic drugs at 24 h postoperatively and the clinical efficacy were compared between the two groups,and the UCLA shoulder rating scale(UCLA shoulder)scores and visual analog scale(VAS)scores were compared before and 2 weeks after surgery.Results The total number of effective cases in the control group was 25,and the total effective rate of treatment was 75.8%,while the total number of effective cases in the observation group was 31,and the total effective rate of treatment was 93.9%.The total effective rate of treatment in the study group was higher than that in the control group,and the difference was statistically significant(χ^(2)=4.243,P=0.039).Before surgery,there was no statistically significant difference between the UCLA shoulder scores of the 2 groups(P>0.05).At 2 weeks after surgery,the UCLA shoulder scores were significantly higher in both groups than before surgery,and the observation group was significantly higher than the control group,and the differences were statistically significant(P<0.05).Before surgery,there was no statistically significant difference between the VAS scores of the 2 groups(P>0.05).At 2 weeks after surgery,the VAS scores of patients in both groups were significantly lower than those before surgery,and the observation group was significantly lower than the control group,and the differences were statistically significant(P<0.05).The first postoperative analgesic time was significantly longer in the observation group than in the control group,and the difference was statistically significant(P<0.05),and the total amount of analgesic drugs used within 24 h after surgery in the observation group was significantly less than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Intra-articular injection of dexmedetomidine combined with ropivacaine is more effective in postoperative analgesia in patients undergoing shoulder surgery,and patients can recover shoulder function significantly.It can also prolong the duration of postoperative analgesia and reduce the dependence on other analgesic drugs after surgery,which is worthy of in-depth clinical study and application.