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摘要 目的 观察静脉注射地塞米松联合右美托咪啶对在超声引导下股神经坐骨神经阻滞麻醉效果的影响。方法 选取2020年10月到2021年7月上海市第六人民医院海口市骨科和糖尿病医院接受超声引导下股神经坐骨神经阻滞麻醉下膝关节镜前交叉韧带重建手术的88例患者，采用随机数字表法分为四组，每组各22例。对照组(A组)，静脉泵注生理盐水；静脉注射地塞米松组(dexamethasone，DD组)，静脉泵注地塞米松5 mg；静脉注射右美托咪啶组(dexmedetomidine，DM组)，静脉泵注右美托咪啶0.5 μg/kg；静脉注射地塞米松+右美托咪啶组(dexamethasone+dexmedetomidine，DD+DM组)，静脉泵注地塞米松5 mg+右美托咪啶0.5 μg/kg。首要评价指标：神经阻滞镇痛持续时间(开始麻醉时间到患者第一次需要镇痛的时间或者疼痛视觉模拟评分≥4分)。次要评价指标：术中阿片药用量；术中心动过缓发生率和低血压发生率；术后神经并发症发生率：肌力减退，麻木；术后恶心呕吐发生率。结果 与A组比较，DD组和DD+DM组的术后镇痛持续时间明显延长(P＜0.05)，DM组镇痛时间无明显延长(P＞0.05)。与DD组比较，DD+DM组的镇痛时间没有明显延长(P＞0.05)。各组均未见心动过缓、低血压、神经损伤的发生。结论 静脉注射地塞米松可延长神经阻滞镇痛时间，但联合右美托咪啶应用未显示明显的协同作用和抵消作用。
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| 关键词 ：
膝关节镜手术,
地塞米松,
右美托咪啶,
术后镇痛,
周围神经阻滞
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| 基金资助:海南省卫生健康委员会课题项目(2001032021A2006) |
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通讯作者:
周全红
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| 作者简介: 薛小云(1983－ )，男，主治医师，上海市第六人民医院海口骨科与糖尿病医院麻醉科，153579907@163.com |
［1］Harbell MW，Cohen JM，Kolodzie K，et al.Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction：a randomized controlled clinical trial［J］.J Clin Anesth，2016，33(9)：68-74.
［2］Maheshwer B，Knapik DM，Polce EM，et al.Contribution of multimodal analgesia to postoperative pain outcomes immediately after primary anterior cruciate ligament reconstruction：A systematic review and Meta-analysis of level 1 randomized clinical trials［J］.Am J Sports Med，2021，49(11)：3132-3144.
［3］Kirkham KR，Grape S，Martin R，et al.Analgesic efficacy of local infiltration analgesia vs.femoral nerve block after anterior cruciate ligament reconstruction：a systematic review and meta-analysis［J］.Anaesthesia，2017，72(12)：1542-1553.
［4］Albrecht E，Vorobeichik L，Jacot-Guillarmod A，et al.Dexamethasone is superior to dexmedetomidine as a perineural adjunct for supraclavicular brachial plexus block：Systematic review and indirect Meta-analysis［J］.Anesth Analg，2019，128(3)：543-554.
［5］Aliste J，Layera S，Bravo D，et al.Randomized comparison between perineural dexamethasone and dexmedetomidine for ultrasound-guided infraclavicular block［J］.Reg Anesth Pain Med，2019，11(7)：rapm2019-100680.
［6］Sehmbi H，Brull R，Ceballos KR，et al.Perineural and intravenous dexamethasone and dexmedetomidine：network meta-analysis of adjunctive effects on supraclavicular brachial plexus block［J］.Anaesthesia，2020，76(7)：974-990.
［7］Zhang P，Liu S，Zhu J，et al.Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy：a prospective randomized study［J］.Reg Anesth Pain Med，2019，8(8)：rapm-2018-100221.
［8］Kirkham KR，Jacot-Guillarmod A，Albrecht E.Optimal dose of perineural dexamethasone to prolong analgesia after brachial plexus blockade：A systematic review and Metaanalysis［J］.Anesth Analg，2018，126(1)：270-279.
［9］Bastos LF，Medeiros DC，Vieira RP，et al.Intraneural dexamethasone applied simultaneously to rat sciatic nerve constriction delays the development of hyperalgesia and allodynia［J］.Neurosci Lett，2012，510(1)：20-23.
［10］Schnabel A，Reichl SU，Weibel S，et al.Efficacy and safety of dexmedetomidine in peripheral nerve blocks：A metaanalysis and trial sequential analysis［J］.Eur J Anaesthesiol，2018，35(10)：745-758
［11］Talke P，Lobo E，Brown R.Systemically administered alpha2-agonist-induced peripheral vasoconstriction in humans［J］.Anesthesiology，〖JP〗2003，99(1)：65-70.
［12］Kang R，Jeong JS，Yoo JC，et al.Effective dose of intravenous dexmedetomidine to prolong the analgesic duration of interscalene brachial plexus block：A single-center，prospective，double-blind，randomized controlled trial［J］.Reg Anesth Pain Med，2018，43(5)：488-495.
［13］Li A，Yuen VM，Goulay-Dufay S，et al.Pharmacokinetic andpharmacodynamic study of intranasal and intravenous dexmedetomidine［J］.Br J Anaesth，2018，120(5)：960-968. |
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