摘要
目的评价不同剂量右美托咪定用于罗哌卡因复合利多卡因臂丛神经阻滞的效果。方法选择手前臂手术患者100例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄18~60岁,体重50~70 kg。采用随机数字表法,将其分为5组(n=20):罗哌卡因复合利多卡因组(RL组)、不同剂量右美托咪定用于罗哌卡因复合利多卡因组(RLD1~4组)。采用经肌间沟及腋路法行臂丛神经阻滞,RL组经肌间沟及腋路分别注射0.25%罗哌卡因+0.5%利多卡因20 mL;RLD1~4组分别注射含右美托咪定[0.5μg/kg(RLD1组)、0.75μg/kg(RLD2组)、1.0μg/kg(RLD3组)、1.5μg/kg(RLD4组)]的0.25%罗哌卡因+0.5%利多卡因20 mL。记录患者一般生命体征:心率(HR)、平均动脉压(MAP)和血氧饱和度(SpO2)的变化,镇痛和运动神经阻滞起效时间、持续时间、镇静程度和呼吸抑制、寒战、呕心呕吐、气胸和局部麻醉药中毒等不良反应并及时处理。结果与RL组比较,RLD1~4组镇痛、运动神经阻滞起效时间,运动神经阻滞持续时间差异无统计学意义(P>0.05),镇痛持续时间延长(P<0.05);在T1~2,RLD1~2组脑电双频指数(BIS)值减少、Ramsay值增加;在T1~3,RLD3~4组BIS值减少、Ramsay值增加,MAP与HR值降低(P<0.05)。与RLD1组和RLD2组比较,RLD3~4组镇痛持续时间延长(P<0.05);在T1~3,BIS值减少、Ramsay值增加(P<0.05);与RLD3组比较,在T2~3,RLD4 BIS值减少、Ramsay值增加(P<0.05)。RLD1~2组间上述指标差异无统计学意义(P>0.05)。与T0比较,在T1~2,RLD1~2组BIS值减少、Ramsay值增加;在T1~3,RLD3~4组BIS值减少、Ramsay值增加,MAP和HR值降低(P<0.05)。RL组中出现1例心率增快、血压升高,少数患者在RLD3~4组中出现心动过缓、低血压,在RLD4组出现过度镇静。结论应用1.0μg/kg右美托咪定加入罗哌卡因复合利多卡因经肌间沟及腋路法行臂丛神经阻滞可以延长镇痛持续时间,镇静程度合适,不良反应少。
Objective To evaluate the efficacy of different doses of dexmedetomidine used in ropivacaine and lidocaine brachial plexus nerve block.Methods One hundred patients with hand forearm surgery,ASA gradeⅠorⅡ,no gender limitation,aged 18-60 years old,weighed 50-70 kg,were selected.They were randomly divided into 5 groups(n=20)by the random number table method:ropivacaine and lidocaine group(RL)and different doses of dexmedetomidine used in ropivacaine and lidocaine groups(RLD1-4).The brachial plexus nerve block was performed by using the interscalene and axillary approach.In the group RL,the interscalene and axillary brachial approach was respectively injected by 0.25%ropivacaine+0.5%lidocaine 20 mL.In the group RLD1-4,20 mL of 0.25%ropivacaine+0.5%lidocaine containing dexmedetomidine(0.5μg/kg in the group RLD1,0.750μg/kg in the group RLD2,1.0μg/kg in the group RLD3 and 1.5μg/kg in the group RLD4)were injected.The changes of general vital signs such as the heart rate(HR),mean arterial pressure(MAP)and oxygen saturation(SpO2)were recorded.The onset time and duration time of analgesiaand motor block,and sedation degree were recorded.The adverse effects such as respiratory depression,chills,nausea and vomiting,pneumothorax and local anesthetic drugs g intoxication were also recorded and promptly treated.Results Compared with the group RL,the onset time of motor nerve block and analgesia,and duration time of motor nerve block in the group RLD 1-4 had no statistically significant difference(P>0.05),the duration time of analgesia was prolonged(P<0.05);the BIS value at T1-2 in the group RLD1-2 was decreased,the Ramsay value was increased;the BIS value at T1-3 in the group RLD3-4 was decreased,the Ramsay value was increased.The MAP and HR values were decreased(P<0.05).Compared with the group RLD1 and RLD2,the duration time of analgesia in the group RLD3-4 was prolonged(P<0.05);the BIS value at T1-3 was decreased,the Ramsay value was increased(P<0.05);compared with the group RLD 3,the BIS value at T2-3 in the group RLD4 was decreased and the Ramsay value was increased(P<0.05).The difference in the above indexes between the group RLD1 and RLD2 had no statistical significance(P>0.05).Compared with T0,the BIS value at T1-2 in the group RLD1-2 was decreased and the Ramsay value was increased;the BIS value at T1-3 in the group RLD3-4 was decreased,the Ramsay value was increased,and the MAP and HR values were decreased(P<0.05).In the group RL,there was 1 case of HR increase and BP elevation.Few patients in the group RLD3-4 developed bradycardia and hypotension,the excessive sedation in the group RLD4 appeared.Conclusion 1.0μg/kg dexmedetomidine adding to ropivacaine and lidocaine interscalene and axillary brachial plexus nerve block can extend the duration of analgesia,the degree of sedation is appropriate and side effects are fewer.
作者
罗铁山
黄建成
赵涛
雷毅
彭铖
胡芸
王晓军
LUO Tieshan;HUANG Jiancheng;ZHAO Tao;LEI Yi;PENG Cheng;HU Yun;WANG Xiaojun(Department of Anesthesiology,General Hospital of Xinjiang Military Region,Wulumuqi,Xinjiang 830000,China)
出处
《重庆医学》
CAS
2021年第14期2463-2468,共6页
Chongqing medicine
