摘要
目的评价右美托咪定联合罗哌卡因术前髂筋膜间隙阻滞对于老年股骨近端骨折患者体位改变的镇痛效果。方法选择行择期股骨颈骨折和粗隆间骨折手术患者80例,年龄60~80岁,ASA分级Ⅱ~Ⅲ级,随机均分为罗哌卡因组(R组)和右美托咪定联合罗哌卡因组(DR组),两组患者于入室前30min行髂筋膜间隙阻滞,R组给予0.3%罗哌卡因(耐乐品)30mL,DR组0.3%罗哌卡因加1μg/kg右美托咪定混合液30mL。分别记录两组患者神经阻滞前(T0)、入手术室(T1)、过床时(T2)、摆放侧卧位时(T3)以及改为平卧位后10min(T4)4个时点的VAS疼痛评分以及Ramsay镇静评分,并记录术后48h穿刺部位出血或血肿,局麻药中毒,心动过缓,低血压、过度镇静等术后不良反应的发生情况。结果DR组VAS疼痛评分在T1~T3时点低于D组,T1~T44个时点Ramsay镇静评分DR组均高于D组,两组不良反应差别无统计学意义。结论1μg/kg右美托咪定联合罗哌卡因应用于老年股骨近段手术中,能够有效减轻摆放体位过程中产生的疼痛反应,同时具有一定程度的镇静作用。
Objective To evaluate the efficacy of Fascia iliac compartment nerve block (FICB) with dexmedetomidine combined with ropivacaine for analgesia during position changes in elderly patients suffering from proximal femoral fractures.Methods 80 patients with selective femoral neck fracture and intertrochanter fracture,ASA grade Ⅱ~ III,were randomly divided into ropivacaine group (R group) and dexmetiomide combined with ropivacaine group (DR group).In the two groups,Iliofascias space block were undertaken 30 min before entering the operating room,and the R group was given 0.3% procaine (tolerance) in 30 mL,and 0.3% of the DR group was added with 1 μg/ kg dexmedetomidine mixed solution for 30 mL.The pain scores of VAS and Ramsay sedation scores in the two groups were recorded respectively before nerve block (T 0),after entering the operating room (T 1),when crossing the bed (T 2),when lateral position was placed (T 3),and in 10 minutes after their position was changed into supine position (T 4).Hemorrhage or hematoma at the puncture site,local anesthetic poisoning,bradycardia,hypotension,excessive sedation and other adverse reactions within 48 h after surgery were also recorded.Results Pain scores of VAS at T 1 ~T 3 time points in the DR group were lower than those in the D group,and the Ramsay sedation scores at T 1 ~T 4 four time points in the DR group were higher than those in the D group.There was no statistically difference in adverse reactions between the two groups.Conclusion 1 μg/kg dexmedetomidine combined with ropivacaine can effectively alleviate the pain response caused by the change of position for the elderly patients with proximal femoral fracture,with a certain degree of sedative effect simultaneously.
作者
王皓
尚游
Wang Hao;Shang You(Department of Anesthesiology,the First Affiliated Hospital to Jinzhou Medical University,Jinzhou 121000 China)
出处
《锦州医科大学学报》
CAS
2019年第4期48-51,共4页
Journal of Jinzhou Medical University
