摘要
目的 将右美托咪定（dexmedetomidine,Dex）和咪达唑仑分别用于臂丛神经阻滞患者,对其效果进行比较,并寻找Dex用于臂丛神经阻滞的合适负荷剂量. 方法 择期行上肢手术患者80例,按随机数字表法分为Dex组（D1组、D2组、D3组）和咪达唑仑组（M组）,每组20例.4组分别于超声引导臂丛神经阻滞前10 min静脉输注Dex（0.3、0.5 μg/kg和0.8μg/kg）和咪达唑仑（0.05 mg/kg）,输注后Dex组和M组分别给予0.5 μg·kg-l·h-1Dex和0.05 mg·kg-1·h4咪达唑仑维持镇静.记录用药前（To）、用药5 min（T1）、臂丛阻滞前即刻（T2）、臂丛阻滞后即刻（T3）、切皮时（T4）及用药30 min （T5）、40 min（T6）、60 min（T7）时的MAP、HR、Sp02、警觉/镇静（observers assessment of alertness/sedation scale,OAMS）评分,并记录发生的副作用. 结果 各组间MAP、HR差异无统计学意义（P＞0.05）,M组在T5时SpOz低于其他3组（P＜0.05）;D1组OAA/S评分在TrT7时高于M组（P＜0.05）,D2组各时点OAA/S评分与M组比较,差异无统计学意义（P＞0.05）,D3组OAA/S评分在T3～T5时明显低于M组P＜0.05）.Dex组低血压的发生率与负荷剂量呈正相关. 结论 Dex较咪达唑仑更适用于臂丛神经阻滞,静脉泵注Dex 0.5 μg/kg后以0.5 μg·kg-1·h-1速率维持可产生良好的镇静效果,且血流动力学较稳定、副作用较小.
Obiective To compare the sedative effects of midazolam and different doses of dexmedetomidine （Dex） in patients undergoing branchial plexus block,and find out the suitable loading dose of Dex.Methods Eighty patients scheduled for upper limb operation were randomly divided into four groups（n=20）：groups Dex（group D1,group D2,group D3） and group midazolam （group M）.The patients in group D1,group D2,group D3 and group M were administered respectively with Dex 0.3,0.5,0.8 μg/kg and midazolam 0.05 mg/kg infusion 10 min before the branchial plexus block under the ultrasound guidance,followed by a maintenance infusion of Dex 0.5 μg·kg-1 ·h-1 or midazolam 0.05 mg·kg-l ·ht respectively.The incidence of adverse effects and,the changes of MAP,HR,SpO2 and the scores of OAA/S before sedative administration （To）,5 min after sedative administration （T3,just before the branchial plexus puncture（T2）,just after the branchial plexus puncture（T3）,the beginning of surgery（T4） and 30 min（Ts）,40 min （T6）,60 min （T7） after sedative administration were recorded.Results At T5,SpO2 in group M were lower as compared to group Dex （P〈0.05）.Compared with group M,the scores of OAA/S were significantly higher in group D1 at T2-T7,while they were significantly lower in group D3 at T3-T5（P〈0.05）,but there were no significant differences in group D2（P〉0.05）.On the other side,the incidence of hypotension exhibited a positive conrelation with the dose of Dex.Conclusions Dex can provide a better sedation than midazolam in this study which means intravenous injection of Dex in 0.5 μg/kg,followed by a maintenance infusion of 0.5 μg·kg-1·h-1 can offer effective sedation for the patients under branchial plexus block and stable hemodynamics as well as less adverse effects.
出处
《国际麻醉学与复苏杂志》
CAS
2016年第9期777-781,共5页
International Journal of Anesthesiology and Resuscitation
