右美托咪定复合舒芬太尼及罗哌卡因硬膜外术后镇痛对下肢骨科手术应激反应和凝血功能的影响

摘要

目的：观察右美托咪定复合舒芬太尼及罗哌卡因硬膜外镇痛对下肢骨科手术应激反应和凝血功能的影响。方法择期行下肢骨科手术患者90例，随机分为D、S1、S2组，每组30例。 D组右美托咪定1．5μg／kg＋舒芬太尼1．0μg／kg＋0．10％罗哌卡因共150 ml，硬膜外镇痛；S1组舒芬太尼1．5μg／kg＋0．10％罗哌卡因共150 ml，硬膜外镇痛，S2组舒芬太尼2．0μg／kg ＋曲马多5 mg／ml 共150 ml，静脉镇痛；3组参数设计，负荷剂量2 ml，背景量2 ml／h，PCA 0．5 ml／次；分别于麻醉前（T0）、术后12 h（T1）、术后24 h（T2）、术后48 h（T3）各时点采集静脉血检测血浆肾上腺素（ E）、去甲肾上腺素（ NE）、皮质醇（ COR）、活化部分凝血活酶时间（ APTT）、凝血酶原时间（ PT）、凝血酶时间（ TT ）、血浆纤维蛋白原（ FIB）值，并于术后T1、T2、T3各时间点对患者进行视觉模拟疼痛评分（ VAS）。结果3组患者T1、T2、T3各时点VAS评分比较差异无统计学意义（ P ＞0．05）。与D组比较，S1组和S2组T1、T2、T3各时点APTT、PT、TT值显著小于D组（ P ＜0．05）；E、NE、COR、FIB值显著高于D组（ P ＜0．05）；与T0比较，D组T1、T2、T3各时点E、NE、COR、FIB、APTT、PT、TT值比较，差异无统计学意义（ P ＞0．05），与S1和S2组T1、T2、T3各时点比较，差异有统计学意义（ P ＜0．05）。结论右美托咪定复合舒芬太尼及罗哌卡因硬膜外镇痛对下肢骨科手术镇痛效果确切，可能降低患者的应激反应及改善患者术后凝血功能。%Objective To observe the effects of epidural postoperative analgesia by dexmedetomidine combined with sufentanil as well as ropivacaine during lower limbs orthopedics on the stress reaction and blood coagulation function of patients.Methods Ninety patients who were going to receive selective lower limbs orthopedics were randomly divided into group D,S1 group and S2 group,with 30 patients in each group.The patients in group D were given dexmedetomidine 1.5μg/kg+sufentanil 1.0μg/kg+0.10%ropivacaine 150ml for epidural analgesia ,and the patients in S1 group were given sufentanil 1.5μg/kg+0.10% ropivacaine 150ml for epidural analgesia,and the patients in S2 group were given sufentanil 2.0μg/kg+tramadol 5mg/ml,totally 150 ml for vein analgesia.The parameter design for three groups was loading dose:2ml, background dose:2ml/h,PCA 0.5 ml every time.The levels of epinephrine (E), norepinephrine (NE),cortisol (COR), activated partial clotting enzyme time ( APTT) , prothrombin time ( PT) , thrombin time ( TT) , plasma fibrinogen ( FIB) were detected before anesthesia (T0), 12h after surgery (T1), 24h after surgery (T2), 48h after surgery (T3), moreover, visual analog pain scoring (VAS) was performed at T1, T2, T3 for three groups.Results There were no significant differences in the VAS scores at T1,T2,T3 among three groups ( P <0.05).As compared with those in group D,the values of APTT, PT, TT at T1,T2,T3 in S1 group and S2 group were significantly lower than those in group D ( P <0.05), however the levels of E,NE,COR,FIB in S1group and S2 group were significantly higher than those in group D ( P <0.05).As compared with those at T0, there were no significant differences in the values of E ,NE,COR,FIB,APTT,PT,TT at T1,T2,T3 in group D (P>0.05),however, there were significant differences in these values between group D and S 1group,S2 group ( P <0.05). Conclusion The effects of epidural postoperative analgesia by dexmedetomidine combined with sufentanil as well as ropivacaine during lower limbs orthopedics are definited ,which may reduce the stress reaction and improve postoperative blood coagulation function of patients .