不同剂量右美托咪定联合罗哌卡因切口浸润用于后路腰椎融合手术患者术后镇痛的效果及安全性探究

Analgesic effects and safety of different doses of dexmedetomidine combined with ropivacaine for incision infiltration after posterior lumbar fusion

目的探究不同剂量右美托咪定联合罗哌卡因切口浸润用于后路腰椎融合手术患者术后镇痛的效果及安全性。方法选取2020年1月~2022年9月本院择期行后路腰椎融合手术治疗的88例患者为研究对象,采用随机数字法分为对照组和观察组各44例,于切口缝合前行切口浸润,对照组给予0.75μg/kg右美托咪定联合0.25%罗哌卡因20 mL,观察组给予1.0μg/kg右美托咪定联合0.25%罗哌卡因20 mL,比较两组VAS评分、术后首次追加镇痛时间、镇痛泵按压次数、镇痛补救率、免疫功能[干扰素γ(IFN-γ)、白细胞介素10(IL-10)、T淋巴细胞亚群(CD_(4)^(+)、CD_(8)^(+))]及不良反应发生情况。结果术后6 h、8 h、12 h、24 h及48 h,观察组VAS评分低于对照组(P<0.05)。观察组首次追加镇痛时间长于对照组,48 h镇痛泵按压次数少于对照组(P<0.05),两组镇痛补救率、24 h镇痛泵按压次数比较无显著差异(P>0.05)。术后12 h、24 h及48 h,观察组IFN-γ、CD_(4)^(+)高于对照组,IL-10、CD_(8)^(+)低于对照组(P<0.05)。两组恶心呕吐、眩晕、心动过缓、低血压等不良反应发生率无显著差异(P>0.05)。结论不同剂量右美托咪定联合罗哌卡因切口浸润对后路腰椎融合手术患者具有良好的镇痛效果,安全性较高,且1.0μg/kg右美托咪定联合罗哌卡因切口浸润效果更好,对免疫功能影响更小。

Objective To explore the analgesic effects and safety of different doses of dexmedetomidine combined with ropivacaine for incision infiltration after posterior lumbar fusion.Methods A total of 88 patients who underwent elective posterior lumbar fusion in the hospital between January 2020 and September 2022 were selected as the research subjects.According to the random number table method,the subjects were divided into the control group(n=44)and the observation group(n=44).Before incision suture,the control group received incision infiltration with dexmedetomidine(0.75μg/kg)combined with 0.25%ropivacaine 20 mL,while the observation group received incision infiltration with dexmedetomidine(1.0μg/kg)combined with 0.25%ropivacaine 20 mL.TheVisual Analogue Scale(VAS)score,postoperative first additional analgesia time,pressing times of analgesic pump,remedy rate of analgesia,immune function[interferonγ(IFN-γ),interleukin-10(IL-10),and T lymphocyte subsets(CD_(4)^(+),CD_(8)^(+))],and the incidence of adverse reactions were compared between the groups.Results VAS scores at 6h,8h,12h,24h and 48h after operationof the observation group were lower than those of the control group(P<0.05).The first additional analgesia time in the observation group was longer than that in the control group,and the pressing times of analgesic pump within 48h were less than those inthe control group(P<0.05).There was no significant difference in the remedy rate of analgesia or pressing times of analgesic pump within 24h between the groups(P>0.05).The levels of IFN-γand CD_(4)^(+)At 12h,24h and 48h after operation in the observation group were higher than those in the control group,while the levels of IL-10 and CD_(8)^(+)were lower than those in the control group(P<0.05).There was no significant difference in the incidence rate of adverse reactions between the groups(P>0.05).Conclusion Different doses of dexmedetomidine combined with ropivacaine for incision infiltration can achieve good analgesic effects after posterior lumbar fusion,with high safety.1.0μg/kg of dexmedetomidine combined with ropivacaine can achieve better incision infiltration effect,and has less influence on immune function.