右美托嘧啶关节腔内注射用于膝关节镜术后镇痛的临床观察

摘要

目的：观察膝关节镜术后膝关节腔内给予两种不同剂量的右美托嘧啶的临床镇痛效果。方法：60例全身麻醉下行膝关节镜手术患者，随机分为三组，每组20例。A组：关节腔内不给予任何药物；D1组：关节腔内注射100μg右美托嘧啶（生理盐水稀释至15 ml）；D2组：关节腔内注射50μg右美托嘧啶（生理盐水稀释至15 ml）。记录术后1、2、8、16、24 h患者静息、运动时的VAS评分，术毕2 h改良的Ramsay镇静评分，术毕首次需要氟比洛芬酯的时间，24 h内氟比洛芬酯的用量以及术后相关的不良反应。结果：与A组比较，D1、D2两组术后1、2、8 h静息与运动时的VAS评分明显降低（ P﹤0.05）；三组术后16、24 h的VAS评分差异无统计学意义（ P﹥0.05）；D1与D2组各时点静息与运动时的VAS评分差异无统计学意义（ P﹥0.05）。D1、D2两组术毕至首次用氟比洛芬酯的时间长于A组，且24 h内氟比洛芬酯总量少于A组，差异有统计学意义（P﹤0.05）。术后2 h改良的Ramsay镇静评分三组间差异无统计学意义（P﹥0.05）。结论：100μg、50μg的右美托嘧啶关节腔内注射可为膝关节镜术后提供短时间的良好的镇痛效果，延长术毕首次需要镇痛药的时间以及减少术后镇痛药的用量。%Objective To observe the analgesic effect of intraarticular two different doses of dexmedetomidine on postoperative analgesia after arthroscopic knee surgery. Method Sixty patients with general anesthesia undergoing arthr- oscopic knee surgery were divided into 3 groups at random in a double-blind placebo controlled study. Group A did not receive intraarticular any drugs,group D1 received intraarticular 100 μg dexmedetomidine and group D2 received intraarticular 50 μg dexmedetomi-dine. Record pain visual analogue scale( VAS),Ramsay sedation score,the time to first postoperative analgesic request,the total postoperative analgesic use during the first 24 hours and drug-related adverse effects. Results The VAS scores in group D1 and group D2 were lower than group A for 1 h,2 h,8 h after operation(P﹤0. 05). There was no statistically significant difference a-mong three groups from 16 h to 24 h after operation( P﹥0. 05 ). The time to first postoperative analgesic request was longer in group D1 and group D2 compared with group A. Total fiurbiprofen axetil requirement was significantly lower in group D1 and group D2 than group A( P﹤0. 05). The Ramsay sedation score at 2 h after operation had no statistically significant difference among three groups(P﹥0. 05). Conclusion Two different doses of dexmedetomidine both provides effective postoperative analgesia after arthroscopic knee surgery,prolonges the first time for postoperative analgesia and reduces the amount of postoperative pain reliv-ers.