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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 743 -747. doi: 10.3877/cma.j.issn.1674-134X.2021.06.015

临床经验

髋关节置换术后右美托咪定增强罗哌卡因的镇痛效果
张治明1, 肖裔兴1, 秦苑1, 赵昀2, 史艳华1,()   
  1. 1. 423000 南华大学衡阳医学院,附属郴州医院(郴州市第一人民医院)麻醉科
    2. 423000 南华大学衡阳医学院,附属郴州医院(郴州市第一人民医院)关节外科
  • 收稿日期:2020-06-15 出版日期:2021-12-01
  • 通信作者: 史艳华
  • 基金资助:
    湖南省自然科学基金支持项目(2019JJ40010)

Dexmedetomidine enhances post-operative analgesic effect of ropivacaine after hip replacement

Zhiming Zhang1, Yixing Xiao1, Yuan Qin1, Jun Zhao2, Yanhua Shi1,()   

  1. 1. Department of Anesthesiology, Affiliated Chenzhou No.1 People’s Hospital, Henyang Medical School, Nanhua University, Chenzhou 423000, China
    2. Department of Joint surgery, Affiliated Chenzhou No.1 People’s Hospital, Henyang Medical School, Nanhua University, Chenzhou 423000, China
  • Received:2020-06-15 Published:2021-12-01
  • Corresponding author: Yanhua Shi
引用本文:

张治明, 肖裔兴, 秦苑, 赵昀, 史艳华. 髋关节置换术后右美托咪定增强罗哌卡因的镇痛效果[J]. 中华关节外科杂志(电子版), 2021, 15(06): 743-747.

Zhiming Zhang, Yixing Xiao, Yuan Qin, Jun Zhao, Yanhua Shi. Dexmedetomidine enhances post-operative analgesic effect of ropivacaine after hip replacement[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 743-747.

目的

观察髋关节置换术中右美托咪定关节囊注射(JCI)是否可增强罗哌卡因镇痛效果。

方法

98例来自郴州市第一人民医院ASA(美国麻醉医师协会)Ⅱ~Ⅲ拟在全麻下行首次髋关节置换的患者,根据JCI情况分为3组:对照组(生理盐水),R组(罗哌卡因),RD组(罗哌卡因加右美托咪定)。手术结束前,根据分组不同,实施关节囊注射。手术时长、出血量、输液量、复苏室停留时间、病人自控止痛(PCA)次数等资料使用单因素方差分析,静态痛、动态痛、恶心感等的视觉模拟评分(VAS)使用重复测量的方差分析,并发症(嗜睡、呕吐)使用卡方检验分析。

结果

静息痛VAS评分3组之间差异均有统计学意义(F=17.62,P<0.05);与对照组比较,R组和RD组差异均有统计学意义(均为P<0.05); RD组比R组评分更低(P<0.05)。动态痛VAS评分3组差异有统计学意义(F=27.97,P<0.05);在不同时点R组和RD组均低于对照组(均为P<0.05);RD组比R组评分更低(P<0.05)。恶心痛VAS评分3组整体表现差异有统计学意义(F=63.3,P<0.05);在不同时间点,R组和RD组均低于对照组(均为P<0.05); T2至T4时间点的RD组和R组比较差异有统计学意义(均为P<0.05)。对照组、R组及RD组复苏室停留时间、嗜睡及呕吐病例占比差异无统计学意义(均为P>0.05)。

结论

髋关节置换手术中,右美托咪定关节囊周注射可以增强罗哌卡因的镇痛效果。

Objective

To see whether dexmedetomidine joint-capsule-injection (JCI) could enhance ropivacaine analgesic effect in hip replacement.

Methods

Ninety-eight patients of American Society of Anesthesiologists(ASA)grading Ⅱ-Ⅲ from Chenzhou No.1 People’s Hospital were divided into three groups according to drugs of JCI: normal saline (the control group), ropivacaine(group R), ropivacaine plus dextrometeridine (group RD). According to the assignment of different groups, the injections were injected around the capsula-articularis before the end of the surgery. One way ANOVA was used to analyze the length of operation, the amount of bleeding, the amount of infusion, length of stay in post-anesthesia-care-unit (STPACU) and patient controlled anagesia (PCA)times. Repeated measurement analysis of variance was used to analyze visual analogue scale (VAS) of static pain, dynamic pain and nausea feeling, chi-square test was applied to analyze incidence of somnolence and vomiting.

Results

The overall difference in VAS score of static pain was statistically significant in the three groups (F=27.97, P<0.05). Comparing with the control group, VAS scores of static pain in group R and group RD were much lower (all P<0.05) ; the score of group RD was lower than group R (P<0.05). The three groups showed significantly statistical difference in VAS of dynamic pain (F=17.62, P<0.05). In VAS of dynamic pain, comparing with the control group, group R and group RD were much lower at different time points (all P<0.05); the score was lower in group RD than group R (P<0.05). The overall performance of the three groups was statistically different in VAS of nuausea (F=63.3, P<0.05). VAS scores of nausea in group R and group RD at different time points were lower than the control group (all P<0.05). The differences between group RD and group R at T2 to T4 were statistically significant (all P<0.05). There was no significant difference among the three groups of STPACU, the somnolence and vomiting incidences (all P>0.05).

Conclusion

In hip-replacement, JCI with ropivacaine plus dexmedetomidine will get better analgesic effects compareed with ropivacaine alone or normal saline.

图1 临床观察的流程注:R组-0.5%罗哌卡因20 ml;RD组-0.5%罗哌卡因+1 μg/kg右美托咪定;PACU-麻醉后复苏室
表1 3组患者一般情况以及手术情况的比较
图2 3组给药患者在不同时间点多项VAS(视觉模拟评分)比较。图A为静态疼痛VAS评分比较;图B为动态疼痛VAS评分比较;图C为恶心感VAS评分比较注:*-3组比较整体差异,P<0.05;a-和对照组比较P<0.05;b-和R组比较P<0.05;T1-离开复苏室时;T2-次日清晨;T3-次日傍晚;T4-第3日清晨;T5-第3日下午;R组-0.5%罗哌卡因20 ml;RD组-0.5%罗哌卡因+1 μg/kg右美托咪定;对照组-生理盐水20 ml
表2 三组患者复苏、镇痛及并发症情况的比较
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