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Received:February 14, 2022 Published Online:September 20, 2022
Received:February 14, 2022 Published Online:September 20, 2022
中文摘要: 目的 探讨右美托咪定复合罗哌卡因髂筋膜阻滞（FIB）对老年高血压患者止血带相关高血压（TIH）和术后疼痛的影响。方法 选取如东县人民医院和南通大学附属医院2021年1月至2022年1月择期全麻下行全膝置换术老年患者120例，随机分为右美托咪定复合罗哌卡因FIB组（DR组）、罗哌卡因FIB组（R组）和空白对照组（C组），每组各40例。DR组诱导后5 min于髂筋膜下给予右美托咪定0.5 μg/kg+0.33%罗哌卡因混合液30 ml，R组患者给予0.33%罗哌卡因30 ml，C组仅接受全身麻醉。记录患者入室后(T0)、诱导后5 min（T1）、止血带充气30 min（T2）、充气1 h（T3）、放气前 （T4）、放气后5 min（T5）时的MAP、HR；记录术中TIH发生率和血管活性药物使用率；记录T0和T5时乳酸浓度；记录术后1、6、12和24 h 静息时和活动后VAS评分；记录术后补救性镇痛和不良反应发生情况。结果 与T0相比，三组患者的MAP、HR在T1时明显降低（P<0.05），而MAP在T2～T4时明显升高（P<0.05），HR在T2时明显加快（P<0.05）；与C组相比，DR组和R组患者的MAP在T2～T4时明显降低（P<0.05），术中TIH发生率和降压药物的使用率明显下降（P<0.05），术后1、6、12和24 h静息时和活动后VAS评分明显降低（P<0.05），术后补救性镇痛率明显降低（P<0.05），而T5时乳酸浓度以及不良反应发生率差异无统计学意义（P＞0.05）。结论 右美托咪定复合罗哌卡因髂筋膜阻滞可以降低老年TIH发生率、稳定血流动力学，具有良好的镇痛效果，且不增加心动过缓、低血压、口干、恶心呕吐等不良反应的发生率。
Abstract:Objective To investigate the influences of dexmedetomidine combined with ropivacaine in fascia iliaca block (FIB) on tourniquet-related hypertension (TIH) and postoperative pain in elderly hypertensive patients.Methods A total of 120 elderly patients who underwent elective total knee replacement under general anesthesia in Rudong People's Hospital and Affiliated Hospital of Nantong University were selected and randomly divided into dexmedetomidine combined with ropivacaine for FIB group (DR group, n=40), ropivacaine for FIB group (R group, n=39) and blank control group (C group, n=39). At 5 minutes after induction of general anesthesia, FIB was performed with a mixture (30 ml) of dexmedetomidine 0.5 μg/kg+0.33% ropivacaine in DR group and with 30 ml of 0.33% ropivacaine in R group, and general anesthesia alone was conducted in C group. MAP and HR were recorded after entering operation room(T0),5 minutes after induction (T1), tourniquet inflation for 30 minutes (T2), tourniquet inflation for 1 hour (T3), before tourniquet deflation(T4) and 5 minutes after deflation (T5). The following indicators were observed and recorded respectively, including the incidence of TIH and the use of vasoactive drugs during operation, the lactic acid concentration at T0 and T5, resting and post-active VAS scores at 1-, 6-, 12- and 24-hour after operation, the proportion of postoperative remedial analgesia and the adverse reactions. Results Compared with those at T0, MAP and HR decreased significantly at T1 (P<0.05), while MAP increased significantly at T2 and T4 (P<0.05), and HR increased significantly at T2 in three groups (P<0.05). Compared with group C, the MAP of patients in DR group and R group was significantly decreased from T2 to T4 (P<0.05), the incidence of intraoperative TIH and the use rate of antihypertensive drugs were significantly decreased (P<0.05), the VAS scores at rest and after activity were significantly decreased at 1, 6, 12 and 24 hours after operation (P<0.05), and the rate of postoperative analgesia was significantly reduced (P<0.05), while the lactic acid concentration and the incidence of adverse reactions at T3 were not statistically significant (P>0.05). Conclusion For the elderly hypertensive patients undergoing total knee replacement, dexmedetomidine combined with ropivacaine in fascia iliaca block can reduce the incidence of tourniquet-related hypertension and stabilize hemodynamics without increasing the incidence of adverse reactions.
文章编号： 中图分类号：R614 文献标志码：B
基金项目:国家自然科学基金（82101291）
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