| 张 宇,汪俊霞,诸源江,向继林,张 兰.右美托咪定联合罗哌卡因连续股神经阻滞对全膝关节置换术后患者镇痛效果、炎性因子和神经递质的影响[J].,2020,(21):4105-4108 |
| 右美托咪定联合罗哌卡因连续股神经阻滞对全膝关节置换术后患者镇痛效果、炎性因子和神经递质的影响 |
| The Effect of Dexmedetomidine Combined with Ropivacaine for Continuous Femoral Nerve Block on Analgesia, Inflammatory Factors and Neurotransmitters in Patients after Total Knee Arthroplasty |
| 投稿时间：2020-04-10 |
| DOI：10.13241/j.cnki.pmb.2020.21.023 |
| 中文关键词: 右美托咪定 全膝关节置换术 连续股神经阻滞 镇痛效果 罗哌卡因 炎性因子 神经递质 |
| 英文关键词: Dexmedetomidine Total knee arthroplasty Continuous femoral nerve block Analgesic effect Ropivacaine Inflammatory factor Neurotransmitter |
| 基金项目:四川省医学科研青年创新项目（Q18855） |
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| 中文摘要: |
| 摘要 目的：探讨右美托咪定联合罗哌卡因连续股神经阻滞对全膝关节置换术（TKA）后患者镇痛效果、炎性因子和神经递质的影响。方法：选取2017年2月~2019年12月期间我院收治的行TKA的患者98例，采用随机数字表法分为对照组和研究组，各49例。对照组给予罗哌卡因连续股神经阻滞，研究组在对照组的基础上联合右美托咪定，比较两组患者镇痛效果、炎性因子、神经递质和不良反应。结果：两组术后1h、6h、12h、24h、48h静息及运动状态的视觉疼痛模拟评分法（VAS）评分均呈先升高后降低趋势（P<0.05）；研究组术后1h、6h、12h、24h、48h静息及运动状态的VAS评分均低于对照组（P<0.05）。两组术前、术后24h、术后48h白介素-1β（IL-1β）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）呈先升高后下降趋势，但研究组术后24h、术后48hIL-1β、IL-6、TNF-α低于对照组（P<0.05）。两组术前、术后24h、术后48h P 物质、β-内啡肽及孤啡肽呈先升高后下降趋势，但研究组术后24h、术后48h P 物质、β-内啡肽及孤啡肽低于对照组（P<0.05）。两组不良反应发生率对比未见统计学差异（P>0.05）。结论：行TKA患者采用罗哌卡因联合右美托咪定连续股神经阻滞，术后镇痛效果确切，可减少炎性因子和神经递质水平，且不增加不良反应发生率，安全性佳。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of dexmedetomidine combined with ropivacaine for continuous femoral nerve block on analgesia, inflammatory factors and neurotransmitters in patients after total knee arthroplasty (TKA). Methods: From February 2017 to December 2019, 98 patients who underwent TKA in our hospital were selected, they were divided into control group and study group by random number table method, each group with 49 cases. The control group was given ropivacaine for continuous femoral nerve block, and the study group was combined with dexmedetomidine on the basis of the control group, the analgesic effect, inflammatory factors, neurotransmitters and adverse reactions of the two groups were compared. Results: The visual pain simulation score (VAS) of resting and exercise state of the two groups at 1h, 6h, 12h, 24h, 48h after operation showed a trend of first increase and then decrease (P<0.05), and the VAS score of resting and exercise state of the study group at 1h, 6h, 12h, 24h, 48h after operation were lower than those of the control group (P<0.05). The interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) of the two groups before operation, 24h, 48h after operation increased first and then decreased, but IL-1 β, IL-6 and TNF - α of the study group were lower than those of the control group at 24h and 48h after operation (P<0.05). Substance P, β-endorphin and orphanin FQ of the two groups before operation, 24h, 48h after operation increased first and then decreased, but substance P, β-endorphin and orphanin FQ of the study group were lower than those of the control group at 24h and 48h after operation (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Dexmedetomidine combined with ropivacaine for continuous femoral nerve block in TKA patients, the analgesic effect after operation is definite, which can reduce the level of inflammatory factors and neurotransmitters, without increasing the incidence of adverse reactions, and has a good safety. |
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