天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (11): 1151-1156.doi: 10.11958/20191806

• 临床研究 • 上一篇    下一篇

超声引导下右美托咪定联合罗哌卡因行髂筋膜间隙阻滞在股骨手术围术期的镇痛效果

杨蓉蓉，徐兴国，黄新冲   

  1. 南通大学附属医院麻醉科（邮编 226001）
  • 收稿日期:2019-06-17 修回日期:2019-07-22 出版日期:2019-11-15 发布日期:2019-12-17
  • 通讯作者: 杨蓉蓉 E-mail:yangr_ongr@yeah.net

Analgesia effect of conducting ultrasound-guided fascia iliaca compartment block by dexmedetomidine combined with ropivacaine in femoral surgery during perioperative period

YANG Rong-rong,XU Xing-guo,HUANG Xin-chong   

  1. Department of Anesthesiology, the Affiliated Hospital of Nantong University, Nantong 226001, China
  • Received:2019-06-17 Revised:2019-07-22 Published:2019-11-15 Online:2019-12-17

PDF (PC)

4480

摘要： 目的 探究股骨手术围术期应用超声引导下右美托咪定（Dex）联合罗哌卡因行髂筋膜间隙阻滞（FICB）的镇痛效果及安全性。方法 2016年 6月—2019年 3月我院行股骨手术治疗的 102例患者根据围术期镇痛方法不同分为 Dex组和对照组。Dex组 55例，全麻前行 Dex联合罗哌卡因行超声引导下 FICB；对照组 47例，全麻前仅给予罗哌卡因行超声引导下 FICB，记录术中瑞芬太尼使用量及术后清醒时间、拔管时间，分别采用疼痛视觉模拟评分（VAS）法、Ramsay镇静评分评定镇痛、镇静效果，并记录不良反应情况。结果 Dex组术中瑞芬太尼使用量明显少于对照组［（0.68±0.17）vs（. 0.79±0.19）mg，P＜0.01］。Dex组麻醉诱导前，术后 6、12、24 h患肢制动下、患肢股四头肌等长收缩下的疼痛 VAS 评分均低于对照组（均 P＜0.05）；且 Dex 组术后 12、24、72 h 时镇痛泵内舒芬太尼的消耗量［（11.10±1.93）、（25.15±5.62）、（60.56±8.65）μg］低于对照组［（14.34±2.67）、（31.64±7.12）、（92.49±13.83）μg，均 P＜0.05］。2组围术期各时点 Ramsay镇静评分比较差异均无统计学意义。2组均有多种不良反应出现，但发生率均较低，其中 Dex组口干发生率高于对照组（16.36% vs.4.26%，P＜0.05），其余不良反应发生率比较差异均无统计学意义。结论 股骨手术围术期应用超声引导下 Dex联合罗哌卡因行 FICB可发挥良好的镇痛效果，可减少术中、术后镇痛药物的使用，且不影响镇静效果，安全性较好，但需注意术后口干症状。

关键词: 镇痛, 股骨, 围手术期, 股骨手术, 右美托咪定, 罗哌卡因, 髂筋膜间隙阻滞

Abstract: Objective To investigate the analgesia effect and safety of conducting ultrasound-guided fascia iliaca compartment block (FICB) by dexmedetomidine (Dex) combined with ropivacaine in femoral surgery during perioperative period. Methods During the period from June 2016 to March 2019, 102 patients who underwent femoral surgery in the hospital were included, and patients were divided into Dex group (n=55, ultrasound-guided FICB by Dex combined with ropivacaine before general anesthesia) and control group (n=47, ultrasound-guided FICB by ropivacaine before general anesthesia) according to different analgesia methods during perioperative period. The intraoperative dosage of remifentanil,postoperative awake time and extubation time were recorded. The pain visual analogue scale (VAS) and Ramsay sedation score were performed to assess analgesia and sedation effects, respectively. The adverse reactions were also recorded.Results The intraoperative dosage of remifentanil was significantly less in Dex group than that in control group [(0.68± 0.17) vs. (0.79±0.19) mg, P＜0.01]. Before induction of anesthesia,VAS scores of limb braking and isometric contraction of quadricepsat 6 h, 12 h, and 24 h after surgery were significantly lower in Dex group than those in control group (all P＜0.05).At 12 h, 24 h and 72 h after surgery, the sufentanil consumption in analgesic pump was significantly lower in Dex group[(11.10±1.93), (25.15±5.62), (60.56±8.65) μg] than that of control group [(14.34±2.67), (31.64±7.12), (92.49±13.83) μg, P＜0.05]. There was no significant difference in Ramsay sedation score between the two groups at any time point during perioperative period. There were multiple adverse reactions in both groups. However, the incidence of them was relatively low. The incidence of dry mouth was significantly higher in Dex group than that in control group (16.36% vs. 4.26%, P＜0.05). There was no significant difference in the incidence of other adverse reactions between the two groups. Conclusion Conducting ultrasound-guided FICB by dexmedetomidine combined with ropivacaine in femoral surgery during perioperative period can play good analgesia effect, which can reduce intraoperative and postoperative usage of analgesics, without affecting sedation effect. And the safety is good, but need to pay attention to postoperative dry mouth symptoms.

Key words: analgesia, femur, perioperative period, femoral surgery, dexmedetomidine, ropivacaine, fascia iliaca compartment block