本文選題：關(guān)節(jié)鏡檢查 + 甲磺酸羅哌卡因��； 參考：《中國全科醫(yī)學(xué)》2017年17期

【摘要】：目的探討膝關(guān)節(jié)鏡手術(shù)后關(guān)節(jié)腔內(nèi)注射甲磺酸羅哌卡因、地佐辛、舒芬太尼及其混合液的鎮(zhèn)痛效果。方法選取2014年11月—2016年1月河北醫(yī)科大學(xué)第三醫(yī)院擇期擬行膝關(guān)節(jié)鏡下單側(cè)半月板切除術(shù)的患者120例,采用隨機(jī)數(shù)字表法分為4組:L組、LD組、LF組、LDF組,每組30例。膝關(guān)節(jié)鏡手術(shù)后,L組給予甲磺酸羅哌卡因178.8 mg關(guān)節(jié)腔內(nèi)注射;LD組給予甲磺酸羅哌卡因178.8 mg+地佐辛10 mg關(guān)節(jié)腔內(nèi)注射;LF組給予甲磺酸羅哌卡因178.8 mg+舒芬太尼10μg關(guān)節(jié)腔內(nèi)注射;LDF組給予甲磺酸羅哌卡因178.8 mg+地佐辛5 mg+舒芬太尼5μg關(guān)節(jié)腔內(nèi)注射。記錄術(shù)前[靜、動(dòng)態(tài)(雙足站立、屈膝90°)]和術(shù)后[術(shù)后2、4 h靜態(tài)及術(shù)后6、12、24 h靜、動(dòng)態(tài)]疼痛視覺模擬評分法(VAS)評分;術(shù)前及術(shù)后2、4、6、12、24 h評價(jià)舒適度評分(BCS);記錄術(shù)前及術(shù)后2、4、6、12、24 h Ramsay鎮(zhèn)靜評分,計(jì)算適宜鎮(zhèn)靜率(2~3分為適宜鎮(zhèn)靜);記錄首次要求補(bǔ)充鎮(zhèn)痛藥物時(shí)間、首個(gè)24h補(bǔ)充鎮(zhèn)痛藥物用量、恢復(fù)獨(dú)立行走所需時(shí)間、鎮(zhèn)痛滿意度、不良反應(yīng)[惡心評分、嘔吐評分及頭暈、尿潴留、皮膚瘙癢、呼吸抑制等]發(fā)生情況。結(jié)果靜態(tài)疼痛VAS評分、動(dòng)態(tài)疼痛VAS評分、BCS比較,治療方法與時(shí)間存在交互作用(P0.05);治療方法主效應(yīng)顯著(P0.05);時(shí)間主效應(yīng)顯著(P0.05)。術(shù)后2、4、24 h 4組適宜鎮(zhèn)靜率比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后6、12 h 4組適宜鎮(zhèn)靜率比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);其中術(shù)后6、12 h LDF組適宜鎮(zhèn)靜率較L組升高(P0.05)。4組首次要求補(bǔ)充鎮(zhèn)痛藥物時(shí)間、首個(gè)24 h補(bǔ)充鎮(zhèn)痛藥物用量、恢復(fù)獨(dú)立行走所需時(shí)間、鎮(zhèn)痛滿意度、惡心評分、嘔吐評分、頭暈及總不良反應(yīng)發(fā)生率比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論關(guān)節(jié)腔內(nèi)注射甲磺酸羅哌卡因、地佐辛、舒芬太尼及其混合液均可緩解膝關(guān)節(jié)鏡手術(shù)后疼痛,但注射3者混合液鎮(zhèn)痛效果較佳、不良反應(yīng)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 擄] 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.
【作者單位】： 河北醫(yī)科大學(xué)第三醫(yī)院關(guān)節(jié)1科;河北醫(yī)科大學(xué)第三醫(yī)院心血管內(nèi)科2科;河北醫(yī)科大學(xué)第三醫(yī)院麻醉2科;
【分類號】：R614

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