摘要
目的 观察超声引导下髂筋膜间隙阻滞复合右美托咪定对单膝关节置换术患者止血带反应及术后恢复的影响。方法 选择2021年8月-2022年3月本院收治的60例ASA分级Ⅰ~级择期行单膝关节置换术的患者作为研究对象,按照随机原则分为实验组和对照组两组,每组各30例。麻醉方法均采用患侧髂筋膜间隙阻滞联合喉罩全麻,两组均在全麻诱导前行患侧超声引导下髂筋膜间隙阻滞,对照组应用0.25%罗哌卡因30 ml,实验组应用右美托咪定1.5μg/kg+0.25%罗哌卡因混合液30 ml,神经阻滞结束测定麻醉效果后行全麻诱导,观察两组患者各时间点[使用止血带前(T0)、使用止血带30 min(T1)、60 min(T2)、90 min(T3),撤除止血带后5 min(T4)]的平均动脉压及心率,术中瑞芬太尼的用量,观察两组苏醒时间、拔除喉罩时间及麻醉恢复室停留时间,观察两组患者术后疼痛视觉模拟评分(VAS)和躁动评分,同时观察两组患者术后24 h40项恢复质量量表(QoR-40)评分。结果 两组患者T1~T4时心率、平均动脉压水平均高于T0时,但实验组T1~T4时平均动脉压、心率均低于对照组(P<0.05);实验组患者术中瑞芬太尼用量、术后VAS评分及躁动评分均低于对照组,差异均有统计学意义(P<0.05),实验组术后24 hQoR-40量表评分明显高于对照组,差异有统计学意义(P<0.05);两组患者苏醒时间、拔除喉罩时间及PACU停留时间比较,差异均无统计学意义(P>0.05)。结论 单膝关节置换术患者使用超声引导下髂筋膜间隙阻滞复合右美托咪定不仅可增强术中神经阻滞效果,有效减轻术中止血带反应,还可以明显减轻术后疼痛及术后躁动,改善术后早期恢复质量,且不会引起苏醒延迟。
Objective To observe the influence of ultrasound-guided fascia iliaca compartment block combined with dexmedetomidine on tourniquet response and postoperative recovery among patients undergoing single knee arthroplasty.Methods Sixty patients with ASA grade of I-II scheduled for single knee arthroplasty in our hospital during August 2021 and March 2022 were enrolled as study subjects,and they were randomly divided into experimental group(n=30)and control group(n=30).All patients were anesthetized with affected side fascia iliaca compartment block combined with laryngeal mask airway general anesthesia.The fascia iliaca space block guided by ultrasound was performed in both groups before induction of general anesthesia.The control group was treated with 0.25%ropivacaine 30 ml,the experimental group was treated with 30 ml compound of dexmedetomidine 1.5μg/kg and 0.25%ropivacaine,the effect of anesthesia was measured at the end of nerve block and then start general anesthesia induction.The mean arterial pressure and heart rate were measured before tourniquet use(T0),30 min after tourniquet use(T1),60 min after tourniquet use(T2),90 min after tourniquet use(T3),and 5 min after tourniquet removal(T 4).The amount of remifentanil used during surgery,the recovery time,laryngeal mask removal time and the time stay in postanesthesia care unit of the two groups were observed;and the visual analogue scale(VAS)and restlessness score were also observed.At the same time,the 40 items recovery quality scale(QoR-40 score)at 24 hours after operation was observed in both groups.Results The heart rate and mean arterial pressure at T1 to T4 were higher than those at T0 in both groups,but the mean arterial pressure and heart rate at T1-T4 in the experimental group were significantly lower than those in the control group(P<0.05).The dose of remifentanil during operation,the VAS score and restlessness score after operation in the experimental group were significantly lower than those in the control group(P<0.05).The score of QoR-40 at 24
作者
谢蕾
Xie Lei(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)
出处
《齐齐哈尔医学院学报》
2023年第18期1727-1731,共5页
Journal of Qiqihar Medical University
关键词
单膝关节置换术
髂筋膜间隙阻滞
右美托咪定
止血带反应
术后恢复
Single knee arthroplasty
Fascia iliaca compartment block
Dexmedetomidine
Tourniquet response
Postoperative recovery
