右美托咪定复合左布比卡因用于下肢骨折手术麻醉的效果研究

Study on the Effect of Dexmedetomidine Combined with Levobupivacaine for Anesthesia in Lower Limb Fracture Surgery

目的:探讨右美托咪定复合左布比卡因股神经阻滞用于下肢骨折麻醉中的效果。方法:选取2020年6月—2022年5月于温州医科大学附属第三医院择期行下肢骨折手术患者86例作为研究对象,按照随机数字表法分为复合组与对照组,各43例。所有患者均予以0.5%左布比卡因100 mg,在此基础上复合组复合右美托咪定1μg/kg,对照组复合相同体积生理盐水,术后均采用自控镇痛泵。比较两组不同时间[麻醉开始前(T_(0))、麻醉开始后30 min(T_(1))、切皮时(T_(2))、切皮后30 min(T_(3))及手术结束时(T_(4))]平均动脉压(MAP)、心率(HR)、感觉阻滞起效与维持时间、术后24 h自控镇痛泵使用次数、肾上腺素(E)、去甲肾上腺素(NE)水平、不良反应发生率。结果:两组T_(1)、T_(3)时MAP、HR水平低于T_(0)时,且复合组T_(2)、T_(3)时MAP、HR水平均低于对照组(P<0.05);复合组感觉阻滞持续时间长于对照组、镇痛次数少于对照组、感觉阻滞起效时间低于对照组(P<0.05);两组术后E、NE水平高于术前,且复合组低于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:右美托咪定复合左布比卡因股神经阻滞用于下肢骨折患者中的麻醉起效快、镇痛效果好,且能减轻应激反应,安全性良好,值得临床应用。

Objective:To investigate the effect of dexmedetomidine combined with levobupivacaine femoral nerve block in anesthesia of lower extremity fracture.Methods:A total of 86 patients who underwent elective lower limb fracture surgery in the Third Affiliated Hospital of Wenzhou Medical University from June 2020 to May 2022 were selected as the research objects.According to the random number table method,they were divided into the composite group and the control group,with 43 cases in each group.All patients were given 0.5% levobupivacaine 100 mg.On this basis,the compound group was combined with dexmedetomidine 1 μg/kg,and the control group was combined with the same volume of normal saline.Mean arterial pressure(MAP),heart rate(HR) at different time [before anesthesia(T_(0)),30 min after anesthesia(T_(1)),skin incision(T_(2)),30 min after skin incision(T_(3)) and at the end of operation(T_(4))],onset and maintenance time of sensory block,frequency of using patient-controlled analgesia pump within 24 h after operation,epinephrine(E) and norepinephrine(NE)levels and incidence of adverse reactions were compared between the two groups.Results:The levels of MAP and HR at T_(1)and T_(3)in the two groups were lower than those at T_(0),and the levels of MAP and HR at T_(2)and T_(3)in the combined group were lower than those in the control group(P<0.05).The duration of sensory block in the combined group was longer than that in the control group,the frequency of analgesia was less than that in the control group,and the onset time of sensory block was lower than that in the control group(P<0.05).The levels of E and NE in the two groups after operation were higher than those before operation,and those in the compound group were lower than 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 levobupivacaine femoral nerve block in patients with lower extremity fracture has rapid anesthetic effect,good analgesic effect,and can reduce stress response,with good safety,which is worthy of clinical application.