关节腔内注射甲磺酸罗哌卡因、地佐辛、舒芬太尼及其混合液对膝关节镜手术后镇痛效果的比较研究

发布时间：2018-04-29 16:51

本文选题：关节镜检查 + 甲磺酸罗哌卡因　；参考：《中国全科医学》2017年17期

【摘要】：目的探讨膝关节镜手术后关节腔内注射甲磺酸罗哌卡因、地佐辛、舒芬太尼及其混合液的镇痛效果。方法选取2014年11月—2016年1月河北医科大学第三医院择期拟行膝关节镜下单侧半月板切除术的患者120例,采用随机数字表法分为4组:L组、LD组、LF组、LDF组,每组30例。膝关节镜手术后,L组给予甲磺酸罗哌卡因178.8 mg关节腔内注射;LD组给予甲磺酸罗哌卡因178.8 mg+地佐辛10 mg关节腔内注射;LF组给予甲磺酸罗哌卡因178.8 mg+舒芬太尼10μg关节腔内注射;LDF组给予甲磺酸罗哌卡因178.8 mg+地佐辛5 mg+舒芬太尼5μg关节腔内注射。记录术前[静、动态(双足站立、屈膝90°)]和术后[术后2、4 h静态及术后6、12、24 h静、动态]疼痛视觉模拟评分法(VAS)评分;术前及术后2、4、6、12、24 h评价舒适度评分(BCS);记录术前及术后2、4、6、12、24 h Ramsay镇静评分,计算适宜镇静率(2~3分为适宜镇静);记录首次要求补充镇痛药物时间、首个24h补充镇痛药物用量、恢复独立行走所需时间、镇痛满意度、不良反应[恶心评分、呕吐评分及头晕、尿潴留、皮肤瘙痒、呼吸抑制等]发生情况。结果静态疼痛VAS评分、动态疼痛VAS评分、BCS比较,治疗方法与时间存在交互作用(P0.05);治疗方法主效应显著(P0.05);时间主效应显著(P0.05)。术后2、4、24 h 4组适宜镇静率比较,差异均无统计学意义(P0.05);术后6、12 h 4组适宜镇静率比较,差异均有统计学意义(P0.05);其中术后6、12 h LDF组适宜镇静率较L组升高(P0.05)。4组首次要求补充镇痛药物时间、首个24 h补充镇痛药物用量、恢复独立行走所需时间、镇痛满意度、恶心评分、呕吐评分、头晕及总不良反应发生率比较,差异均有统计学意义(P0.05)。结论关节腔内注射甲磺酸罗哌卡因、地佐辛、舒芬太尼及其混合液均可缓解膝关节镜手术后疼痛,但注射3者混合液镇痛效果较佳、不良反应小。
[Abstract]:Objective to investigate the analgesic effect of intraarticular injection of ropivacaine mesylate, dizocaine, sufentanil and its mixture after arthroscopy. Methods from November 2014 to January 2016, 120 patients with unilateral meniscal resection under knee arthroscopy were selected from the third Hospital of Hebei Medical University. The patients were randomly divided into 4 groups (n = 30): LDF group (n = 30) and LDF group (n = 30). Group L received ropivacaine mesylate 178.8 mg intraarticular injection LD group 178.8 mg ropivacaine mesylate 178.8 mg dizosin 10 mg intraarticular injection LF group 10 渭 g ropivacaine mesylate 178.8 mg sufentanil 10 渭 g 178.8 mg ropivacaine mesylate 5 mg sufentanil 5 渭 g intraarticular injection was given to the LDF group. The visual analogue scores of pain were recorded before operation [standing on both feet, flexion 90 掳] and after operation [static at 2 hours and 24 hours after operation] and visual analogue score of pain (VAS). Before and after operation, the comfort score was evaluated at 24 h, the Ramsay sedative score was recorded at 24 h before and after the operation, and the appropriate sedative rate was calculated. The time required for the first time to supplement analgesic drugs and the dosage of the first 24 h analgesic drug were recorded, and the results were as follows: (1) before and after operation, the time of analgesic supplement and the dosage of analgesic drug in the first 24 h were recorded, and the optimal sedative rate was calculated. Time required for recovery of independent walking, analgesic satisfaction, adverse reactions [nausea score, vomiting score and dizziness, urinary retention, skin itching, respiratory depression, etc.] Results compared with the static pain VAS score and the dynamic pain VAS score, there was a significant interaction between the treatment method and the time, the main effect of the treatment was significant (P0.05), and the main effect of the treatment was significant (P0.05). There was no significant difference in the appropriate sedation rate between the 4 groups at 24 h after operation (P 0.05) and the appropriate sedation rate at 6 h 12 h after operation. The appropriate sedation rate of LDF group was significantly higher than that of L group at 6 h after operation, and the first time required for the supplement of analgesic drugs, the first 24 h dosage of analgesic drug, the time needed for recovery of independent walking, and the satisfaction degree of analgesia. There were significant differences in the incidence of nausea, vomiting, dizziness and total adverse reactions (P 0.05). Conclusion Intraarticular injection of ropivacaine mesylate, dizocaine, sufentanil and its mixture can relieve pain after knee arthroscopy.
【作者单位】：河北医科大学第三医院关节1科;河北医科大学第三医院心血管内科2科;河北医科大学第三医院麻醉2科;
【分类号】：R614

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