目的 评价右美托咪啶(DEX)复合罗哌卡因超声引导下股神经阻滞对全膝关节置换术患者术后局部炎性反应及镇痛效果的影响.方法 择期行全膝关节置换术患者60例,年龄43~64岁,体质量50~81 kg,性别不限,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者分为两组:罗哌卡因组(R组)和DEX复合罗哌卡因组(DR组),各30例.两组患者入室后,局部麻醉下分别行超声引导下股神经阻滞:R组患者注射0.5%罗哌卡因20 mL;DR组患者注射0.5%罗哌卡因20mL+DEX 1 μg/kg.然后行麻醉诱导和维持,术毕连接静脉自控镇痛泵(PCIA).分别于术后6 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)时,采集患者膝关节腔引流袋中引流液,检测细胞因子IL-6和 TNF-α的浓度;在上述同样时间点,评估记录患者静息和运动情况下的视觉模拟评分(VAS);记录PCIA镇痛泵按压次数;记录患者股神经阻滞并发症的情况.结果 两组患者术后不同时点白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)指标变化,静息和运动VAS评分的整体趋势都是在术后12 h达到峰值,然后再下降的一个过程.与R组比较,DR组患者的IL-6和TNF-α指标以及静息和运动VAS评分,在术后12 h、24 h和48 h的值都低于R组患者,有统计学意义(P<0.05).结论 右美托咪啶复合罗哌卡因超声引导下股神经阻滞可以减轻全膝关节置换术患者术后关节腔局部炎性反应、增强术后镇痛效果.%Objective To evaluate the effect of dexmedetomidine as an adjuvant to ropivacaine on postoperative local inflammatory and postoperative analgesia of patients undergoing total knee arthroplasty under ultrasound guided femoral nerve block.Methods Sixty patients undergoing total knee replacement were including,age range from 43-64 years old,weight range from 50-81 kg,ASA grade I or Ⅱ.All patients were randomly divided into two groups by ran-dom number table:ropivacaine group(R)and dexmedetomidine with ropivacaine group(DR)(n=30).R group received ropivacaine and DR group receiving ropivacaine with dexmedetomidine under ultrasound guided femoral nerve block un -der local anesthesia.Then,total anesthesia induction and anesthesia maintenance were performed,and postoperative pa-tient-controlled intravenous analgesia pump was used.The drainage fluid of knee joint cavity of the patients at 6 h(T1), 12 h(T2),24h(T3)and 48 h(T4)postoperative,were collected,and the concentrations of IL-6 and TNF-αwere detec-ted.The Visual Analog Scale(VAS)of the above-mentioned same time points was recorded;and the nerve block compli-cation and times of PCIA press were also recorded.Results The overall trend of VAS,IL-6 and TNF-αin the two groups were peaked at 12 h after surgery and then decreased.Compared with the R group,the VAS,IL-6 and TNF-αval-ues were lower in the DR group at 12 h,24 h and 48 h postoperative(P<0.05).Conclusion Dexmedetomidine as an adjuvant to ropivacaine can reduce the local inflammatory and increase the analgesic effect in patients undergoing total artificial knee arthroplasty under ultrasound guided femoral nerve block.
展开▼
