摘要
目的：探讨神经阻滞联合右美托咪定用于全膝关节置换术后的镇痛效果。方法2012年5月至2014年8月收集在武警浙江总队医院行全膝关节置换术（TKA）治疗的100例膝关节炎（OA）患者，采用随机数字表法将患者分为观察组和对照组，每组各50例，观察组术前采用罗帕卡因、右美托咪定联合股神经阻滞，对照组采用罗帕卡因联合股神经阻滞，观察术后静息及活动 VAS 评分、镇静 Ramsay 评分、术后 MAP、HR、术后膝 ROM、术后镇痛情况及不良反应发生情况。结果观察组患者术后 T1、T2、T3、T4阶段静息痛、活动痛均明显低于对照组（静息痛 T1～T4（t）＝4．53，9．97，8，44，5．43，P ＜0．05；活动痛 T1～T4（t）＝6．34、7．24、6．43、4．53，P ＜0．05），两组患者 T1、T2、T3、T4阶段镇静 Ramsay 评分、MAP、HR 差异均无统计学意义（均 P ＞0．05），观察组术后1～5 d 膝关节 ROM明显高于对照组（t ＝4．83、6．83、6．52、6．63、6．22，P ＜0．05），两组患者曲马朵首次应用时间差异无统计学意义（P ＞0．05），观察组曲马朵应用率、镇痛泵按压次数及曲马朵应用剂量均明显低于对照组（χ2＝5．32，t ＝4．66、18．20，均 P ＜0．05），两组患者总不良反应发生率差异无统计学意义（χ2＝0．71，P ＝0．40）。结论股神经阻滞联合右美托咪定可有效减轻 TKA 术后疼痛，减少阿片类镇痛药用量，提高膝关节功能，同时并未影响患者血流动力学，安全性较高。
Objective To explore the effect of femoral nerve block combined with dexmedetomidine in perio-perative analgesia for total knee arthroplasty.Methods One hundred patients undergoing total knee arthroplasty and met criterions were collected from May 2012 to August 2014 in General Hospital of Zhejiang People＇s Armed Police Force.They were randomly divided into the observation group and control group.The patients in the observation group received femoral nerve block combined with dexmedetomidine and ropivacaine.And the patients in the control group received femoral nerve block combined with dexmedetomidine.The rest pain,activities pain,Ramsay sedation score, MAP,HR at T1,T2,T3,T4 stage,postoperative knee ROM,postoperative analgesia effect and postoperative adverse reactions were recorded.Results The rest pain and activities pain of patients in the observation group were lower than those in the control group at T1,T2,T3,T4 stage （t resting pain T1 -T4 =4.53,9.97,8,44,5.43,all P 〈0.05;t active pain T1 -T4 =6.34,7.24,6.43,4.53,all P 〈0.05）.The Ramsay sedation score,MAP and HR of the two groups had no significant differences at T1,T2,T3,T4 stage （P 〉0.05）.The postoperative knee ROMof patients in the observation group were higher than those in the control group （t =4.83,6.83,6.52,6.63,6.22,all P 〈0.05）.The tramadol first application time of the two groups had no significant difference （P 〉0.05）.The postopera-tive analgesia pressing times and tramadol usage of patients in the observation group were lower than those in the con-trol group （χ2 =5.32,t =4.66,18.20,all P 〈0.05）.And the difference was not statistically significant regarding to incidence rate of postoperative adverse reactions （χ2 =0.71,P =0.40）.Conclusion Femoral nerve block combined with dexmedetomidine can effectively relieve pain after TKA,reduce the usage of opioids,improve knee function.At the same time,it has no impact on patients＇hemodynamics.It is worthy to be promoted due to high safety and efficacy.
作者
周海鸥
Zhou Haiou(Department of Anesthesia,the Hospital of Armed Police Corps of Zhejiang Province ,Jiaxing,Zhejiang 314000, China)
出处
《中国基层医药》
CAS
2016年第24期3719-3723,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省医药卫生计划项目（2011Kyb052）
关键词
关节成形术
置换
膝
阻滞
股神经
镇痛
右美托咪定
Arthroplasty,replacement,knee
Block
Femoral nerve
Analgesia
Dexmedetomidine
