医学信息
醫學信息
의학신식
Medical Information
2015年
45期
41-42
,共2页
全膝关节置换术%股神经阻滞%术后镇痛%右美托咪定%罗哌卡因
全膝關節置換術%股神經阻滯%術後鎮痛%右美託咪定%囉哌卡因
전슬관절치환술%고신경조체%술후진통%우미탁미정%라고잡인
Total knee arthroplasty%Femoral nerve block%Postoperative analgesia%Dexmedetomidine%Ropivacaine
目的：比较超声联合神经刺激仪引导下右美托咪定复合罗哌卡因股神经阻滞(FNB)对全膝关节置换术(TKA)患者术后镇痛及术后患肢运动功能恢复情况的影响。方法2014年3月~9月将40例全身麻醉下拟行TKA手术的患者随机分为右美托咪定复合罗哌卡因镇痛组(DR组)和罗哌卡因镇痛组(R组),每组20例。在全身麻醉诱导前,两组患者分别接受超声联合神经刺激仪引导下的股神经阻滞。DR组在股神经定位后单次注射150μg右美托咪定+0.5%罗哌卡因40ml,R组注射0.5%罗派卡因40ml。记录两组患者术中及术后镇痛药物使用量、术后静息和活动时的疼痛评分、股四头肌肌力、术后膝关节活动度和术后并发症发生率等。结果 DR组患者感觉运动完全恢复的时间平均为18h而R组为14h(=0.0015)。 DR组患者术中及术后镇痛药物使用量、膝关节活动度、股四头肌肌力、术后4h、6h和24h观察点静息及运动时疼痛评分与R组比较,差异均无统计学意义(>0.05)；术后8~14h各观察时间点静息和活动疼痛评分DR组均优于R组(<0.05)。结论对TKA患者来说,右美托咪定复合罗哌卡因增强镇痛效果,延长作用时间,同时不影响股四头肌肌力,不增加全身不良反应,从而促进患者早期活动和患肢功能恢复。
目的：比較超聲聯閤神經刺激儀引導下右美託咪定複閤囉哌卡因股神經阻滯(FNB)對全膝關節置換術(TKA)患者術後鎮痛及術後患肢運動功能恢複情況的影響。方法2014年3月~9月將40例全身痳醉下擬行TKA手術的患者隨機分為右美託咪定複閤囉哌卡因鎮痛組(DR組)和囉哌卡因鎮痛組(R組),每組20例。在全身痳醉誘導前,兩組患者分彆接受超聲聯閤神經刺激儀引導下的股神經阻滯。DR組在股神經定位後單次註射150μg右美託咪定+0.5%囉哌卡因40ml,R組註射0.5%囉派卡因40ml。記錄兩組患者術中及術後鎮痛藥物使用量、術後靜息和活動時的疼痛評分、股四頭肌肌力、術後膝關節活動度和術後併髮癥髮生率等。結果 DR組患者感覺運動完全恢複的時間平均為18h而R組為14h(=0.0015)。 DR組患者術中及術後鎮痛藥物使用量、膝關節活動度、股四頭肌肌力、術後4h、6h和24h觀察點靜息及運動時疼痛評分與R組比較,差異均無統計學意義(>0.05)；術後8~14h各觀察時間點靜息和活動疼痛評分DR組均優于R組(<0.05)。結論對TKA患者來說,右美託咪定複閤囉哌卡因增彊鎮痛效果,延長作用時間,同時不影響股四頭肌肌力,不增加全身不良反應,從而促進患者早期活動和患肢功能恢複。
목적：비교초성연합신경자격의인도하우미탁미정복합라고잡인고신경조체(FNB)대전슬관절치환술(TKA)환자술후진통급술후환지운동공능회복정황적영향。방법2014년3월~9월장40례전신마취하의행TKA수술적환자수궤분위우미탁미정복합라고잡인진통조(DR조)화라고잡인진통조(R조),매조20례。재전신마취유도전,량조환자분별접수초성연합신경자격의인도하적고신경조체。DR조재고신경정위후단차주사150μg우미탁미정+0.5%라고잡인40ml,R조주사0.5%라파잡인40ml。기록량조환자술중급술후진통약물사용량、술후정식화활동시적동통평분、고사두기기력、술후슬관절활동도화술후병발증발생솔등。결과 DR조환자감각운동완전회복적시간평균위18h이R조위14h(=0.0015)。 DR조환자술중급술후진통약물사용량、슬관절활동도、고사두기기력、술후4h、6h화24h관찰점정식급운동시동통평분여R조비교,차이균무통계학의의(>0.05)；술후8~14h각관찰시간점정식화활동동통평분DR조균우우R조(<0.05)。결론대TKA환자래설,우미탁미정복합라고잡인증강진통효과,연장작용시간,동시불영향고사두기기력,불증가전신불량반응,종이촉진환자조기활동화환지공능회복。
Objective To investgate whether dexmedetomidine added to ropivacaine could safely prolong the duration of analgesia without adverse ef ects when compared with ropivacaine alone in patients after total knee arthroplasty (TKA).Methods We enrol ed 40 patients undergoing elective TKA under general anesthesia with femoral nerve block (FNB).Patients who were randomized into two groups with 20 cases in each group underwent ultrasound and nerve stimulator guided FNB using either 40ml 0.5%ropivacaine(R group) or 0.5%ropivacaine plus 150μg dexmedetomidine(DR group). The primary outcomes were self-reported duration of the nerve block ,analgesic consumption,pain score in rest and movement,the force of quadriceps femoris,activity of knee and complications after surgery.Results The wanning of sensory and motor block in DR group was 18h while it was 14h in R group ( =0.0015).The pain score at rest and activity at postoperative 8~14h in DR group were lower than in R group ( <0.05).No dif erences were found in the pain score at rest and activity at postoperative 4h,6h and 24h,opioids and other analgesics consumption during and after operation, activity of knee and force of quadriceps femoris in patients of both groups ( >0.05).Conclusion Dexmedetomidine added to ropivacaine for FNB increased duration of nerve block and improved postoperative pain.These benefits and results encourage further study in the ef icacy and safety of using dexmedetomidine in peripheral never block in humans.
