张益龙

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（P<0.05）；术后运动阻滞程度评分A组明显高于其他两组（P<0.05）；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 （P>0.05）. The VAS scores at postoperative 12， 24 and 48 hour were significantly lower in group A and C than in group B （P<0.05）. The Bromage scores at postoperative 4， 12， 24 and 48 hour were significantly higher in group A than in group B and C （P<0.05）. No significant differences were found in adverse reactions among the three groups （P>0.05）. 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。目前临床多采用0.2%～0.3%罗哌卡因行术后硬膜外自控镇痛，但有些患者在使用0.2%～0.3%浓度的罗哌卡因行术后硬膜外自控镇痛过程中存在一定的下肢运动障碍情况[1]，影响术后的早期床上运动，增加下肢静脉血栓的发生率。本文观察右美托咪定结合低浓度的罗哌卡因在下肢手术术后硬膜外镇痛中的效果，探讨其疗效和安全性。

1 资料与方法

1.1 一般资料

选择下肢骨科手术60例，其中股骨粗隆间骨折手术26例，股骨上段骨折手术24例，胫骨骨折手术10例。男 32例，女 28例，年龄 25 ～45 岁，体重 46 ～65 kg。ASA 分级Ⅰ-Ⅱ级，患者术前无慢性疼痛疾病、无神经肌肉疾病及心肺功能和肝肾功能障碍，无精神病史。……