王丽萍 任莉 曾路路

[摘要]目的 探讨罗哌卡因局部浸润联合右美托咪啶预防性镇痛对膝关节镜手术后镇痛的影响。方法 选取2016年10月～2017年10月我院骨科收治的120例膝关节镜手术患者作为研究对象，随机分为两组，每组各60例。对照组采用罗哌卡因局部浸润预防性镇痛，观察组采用罗哌卡因局部浸润联合右美托咪啶预防性镇痛，比较两组患者的术后镇痛效果、镇痛药物消耗情况、不良反应。结果 观察组术后1、4、8、12、24、48 h静止相及运动相的VAS评分均明显低于对照组，差异有统计学意义（P<0.05）；观察组术后镇痛持续时间、24 h镇痛药物消耗量明显优于对照组，差异有统计学意义（P<0.05）；观察组恶心呕吐、深度镇静、苏醒期躁动的不良反应总发生率与对照组比较差异无统计学意义（P>0.05）。结论 罗哌卡因局部浸润联合右美托咪啶预防性镇痛对膝关节镜手术后镇痛有明显提升作用，能够减少镇痛药物用量，延长镇痛时间，且不良反应轻微，具有积极的临床意义。

[关键词]膝关节镜手术；罗哌卡因；局部浸润；右美托咪啶；预防性镇痛；术后镇痛效果

[中图分类号] R971.2 [文献标识码] A [文章编号] 1674-4721（2018）7（c）-0076-03

[Abstract] Objective To investigate the effect of ropivacaine local infiltration combined with dexmetidine preventive analgesia on postoperative analgesia after knee arthroscopy. Methods From October 2016 to October 2017， 120 patients undergoing arthroscopic knee surgery treated in our hospital were selected as the subjects， and randomly divided into two groups， 60 cases in each group. The control group was treated with ropivacaine local invasive preventive analgesia， the observation group was treated with ropivacaine local infiltration combined with dexmetidine for prophylactic analgesia. The postoperative analgesia effect， analgesic drug consumption， adverse reactions were compared between the two groups. Results The VAS scores of 1， 4， 8， 12， 24 h and 48 h in the observation group were significantly lower than those in the control group， the difference was statistically significant （P<0.05）. In the observation group， the postoperative analgesic and 24 h analgesic drug consumption was significantly better than the control group， the difference was statistically significant （P<0.05）. There was no significant difference in the total incidence of nausea and vomiting， deep sedation， wakening and restlessness in the observation group （P>0.05）. Conclusion Ropivacaine local infiltration combined with dexmetidine prophylactic analgesia can significantly improve the postoperative analgesia of knee arthroscopy， reduce the amount of analgesic drugs， prolong the analgesic time， and the adverse reaction is mild. It has positive clinical significance.

[Key words] Knee arthroscopic surgery； Ropivacaine； Local infiltration； Dexmetomidine； Preventive analgesia； Postoperative analgesic effect

膝關节镜手术是临床治疗膝关节疾病的有效手段，但术后存在明显的疼痛感，对患者膝关节功能的早期恢复有十分不利的影响[1]。术后严重疼痛可引起机体应激性反应，甚至引发并发症，因此，临床对采取预防性镇痛的方法，以减轻术后疼痛的影响。以往临床多采用关节腔内注射罗哌卡因的方法，短时间镇痛效果良好，但持续性较差，需要反复给药，且容易产生不良反应，使得临床使用受限。现代临床对疼痛治疗多采用联合用药的策略，先用罗哌卡因局部浸润麻醉，再留置导管持续泵注右美托咪啶，以提升镇痛效果，延长镇痛时间，达到更好的镇痛效应[2]。……