右美托咪定复合罗哌卡因对术后硬膜外镇痛60例疗效观察.docVIP

右美托咪定复合罗哌卡因对术后硬膜外镇痛60例疗效观察 　　摘 要 目的：观察右美托咪定联合不同浓度罗哌卡因对硬膜外镇痛的疗效及安全性。方法：选择60例ASAⅠ-Ⅱ级行骨科下肢手术的患者，术后行硬膜外自控镇痛，分为A，B 和C 3组各20例。A组： 0.25%罗哌卡因150 ml；B 组：0.15%罗哌卡因150 ml；C组：右美托咪定1.0 mg/kg+0.15%罗哌卡因150 ml。观察患者术后4、12、24、48 h VAS镇痛、镇静以及平均动脉压、心率的变化，记录术后24 h运动阻滞程度和术后恶心、呕吐、尿储留等不良反应。结果：术后4 h组间VAS疼痛评分差异无统计学意义，术后12、24和48 h A组和C组VAS疼痛评分低于B组（P0.05）；术后运动阻滞程度评分A组明显高于其他两组（P0.05）；术后恶心、呕吐、低血压、心动过缓等不良反应3组差异无统计学意义。结论：右美托咪定复合0.15%罗哌卡因进行硬膜外术后自控镇痛疗效好，同时可以有效减少局麻药引起的下肢神经麻木，运动障碍等不良反应。 　　关键词 右美托咪定 硬膜外术后镇痛 罗哌卡因 　　中图分类号：R614.42； R971.93 文献标识码：B 文章编号：1006-1533（2016）13-0037-03 　　Clinical efficacy of dexmedetomidine combined with ropivacaine on postoperative epidural analgesia 　　ZHANG Yilong 　　（The First Hospital of Longyan City， Longyan 333000， China） 　　ABSTRACT Objective： To observe the efficacy and safety of dexmedetomidine combined with ropivacaine on postoperative epidural analgesia. Methods： A total of 60 patients with ASA I and II undergoing lower limb orthopedic surgery were enrolled and divided into three groups with 20 cases each. Epidural anesthesia was given with 150 ml of 0.25% ropivacaine in group A， 150 ml of 0.15% ropivacaine in group B and 150 ml of 0.15% ropivacaine combined with dexmedetomidine （1 mg/kg） in group C. VAS score， Bromage score， hemodynamic changes and adverse reactions were observed among three groups. Results： No significant differences were found in VAS scores at postoperative 4 hour among the three groups （P0.05）. The VAS scores at postoperative 12， 24 and 48 hour were significantly lower in group A and C than in group B （P0.05）. Conclusion： Dexmedetomidine combined with 0.15% ropivacaine has good efficacy for postoperative epidurai analgesia and can effectively reduce adverse reactions such as lower limb nerve numbness and movement disorders caused by local anesthetics. 　　KEY WORDS ropivaeaine； dexmedetomidine； postoperative epidural analgesia 　　下肢骨折手术是骨科常见手术，患者术后疼痛比较剧烈，会产生应激反应而且持续时间较长。术后疼痛的因素包括肌筋膜的紧张、患肢的术后肿胀、骨膜的刺激、骨间的摩擦感以及手术切口疼痛等，术后给予加压包也会增加术后疼痛的发生率。目前临床多