摘要
目的观察右美托咪定(DEX)复合罗哌卡因腰方肌阻滞对老年髋关节置换手术患者镇痛及应激反应的影响。方法120例髋关节置换手术患者随机分为C、V和N组,3组均行静吸复合麻醉及罗哌卡因腰方肌阻滞,V组增予DEX静脉泵注,N组增予DEX神经周围注射。比较3组患者围术期血压和心率,术后48 h内VAS和舒适度(BCS)评分,血糖(BG)、肾上腺素(E)、去甲肾上腺素(NE)水平,术后追加曲马多、镇痛泵按压例次及术后不良反应。结果V组T2、T3时点和N组T3时点HR低于同期C组(P<0.01)。V组T6-7 VAS评分低于同期C组,T4-7 BCS评分高于同期C组。N组T4-7、T6-7 VAS评分分别低于同期C组、V组,BCS评分高于同期C组(P<0.05)。V、N组T3、T6、T7 BG、E、NE水平低于同期C组(P<0.05)。N组T1 NE水平低于同期C、V组,T3 BG水平低于V组,术后需追加曲马多例数及镇痛泵按压例次少于C组(P<0.05或0.01)。结论老年髋关节置换手术中右美托咪定静脉输注或神经周围注射可增强罗哌卡因腰方肌阻滞效果,延长罗哌卡因作用时间,减弱应激反应,且以神经周围注射的效果更佳。
Objective To observe the effects of dexmedetomidine(DEX)and ropivacaine quadratus lumborum block on analgesia and stress response in elderly patients with hip arthroplasty.Methods A total of 120 patients with hip arthroplasty were randomly divided into control group(group C),intravenous DEX(group V)and perineural DEX(group N)and treated with intravenous inhalational anesthesia and ropivacaine quadratus lumborum block.Perioperative blood pressure and heart rate(HR);Visual Analogue Scale(VAS)and Bruggrmann comfort scale(BCS)during 48 h postoperation;blood glucose(BG),epinephrine and norepinephrine levels;postoperative additional tramadol,analgesic pump pressing,and adverse reactions were compared among three groups.Results HR at T2 and T3 in group V and at T3 in group N was lower than in group C(P<0.01).Compared with group C,VAS at T6/7 was lower,while BCS at T4-7 was higher in group V.In group N,VAS at T4-7 and at T6/7 was respectively lower than that of groups C and V,but BCS was higher than that of group C(P<0.05).BG,epinephrine and norepinephrine levels at T3,T6 and T7 were lower in groups V and N than in group C(P<0.05).In group N,norepinephrine content at T1 was lower than in groups C and V,BG at T3 in group V,and postoperative additional tramadol and analgesic pump pressing frequency in group C(P<0.05 or 0.01).Conclusion Intravenous or perineural DEX can enhance analgesic effect of ropivacaine quadratus lumborum block in elderly patients with hip arthroplasty,prolong action time of ropivacaine,and weaken stress response,with the better effect of perineural DEX.
作者
张晓欣
彭学强
杜燕燕
朱小兵
吴论
楼莹莹
ZHANG Xiao-xin;PENG Xue-qiang;DU Yan-yan;ZHU Xiao-bing;WU Lun;LOU Ying-ying(Department of Anesthesiology,Affiliated Zhongshan Hospital of Traditional Chinese Medicine,Guangzhou University of Chinese Medicine,Zhongshan 528400,China)
出处
《广东医科大学学报》
2022年第1期85-88,共4页
Journal of Guangdong Medical University
关键词
髋关节置换
右美托咪定
腰方肌阻滞
hip arthroplasty
dexmedetomidine
quadratus lumborum block
