盐酸右美托咪定复合罗哌卡因对超声引导下臂丛神经阻滞效果的影响

摘要

目的：探讨盐酸右美托咪定在超声引导下臂丛神经阻滞中应用的临床效果。方法：南通大学附属医院于2015年2至8月收治B超引导下肌间沟臂丛神经阻滞的60例患者，将其随机分为实验组和对照组，每组30例。对照组患者在麻醉时给予罗哌卡因75 mg ；实验组患者在对照组给药的基础上给予1．0μg／kg的盐酸右美托咪定。比较两组患者入室时（T0）、麻醉后10 min（T1）、手术开始时（T2）、手术开始后30 min（T3）以及手术结束时（T4）的心率（HR）、血氧饱和度（SpO2）、平均动脉压（MAP）以及镇静评分（Ramsay评分）；同时观察各组患者感觉及运动阻滞起效时间、持续时间以及镇痛持续时间；并观察和记录各组患者不良反应发生情况。结果：实验组患者 T1、T2时的MAP、HR均显著低于T0，且显著低于对照组（P＜0．01）；实验组患者T1、T2、T3、T4的Ramsay评分均高于T0，且高于对照组（P＜0．05）；实验组患者感觉阻滞起效时间、运动阻滞起效时间均显著短于对照组（P＜0．05），而感觉阻滞持续时间、运动阻滞持续时间以及镇痛持续时间则长于对照组（P＜0．01）。两组患者不良反应差异无统计学意义。结论：盐酸右美托咪定复合罗哌卡因能够显著缩短局麻药的起效时间，延长感觉阻滞时间、运动阻滞时间和术后镇痛时间。%Objective: To investigate the clinical effect of dexmedetomidine in ultrasound‐guided brachial plexus block .Methods :Totally 60 cases with ultrasound‐guided brachial plexus block in Affiliated Hospital of Nantong University were divided into experimental group and control group ,with 30 cases in each group .The ropivacaine 75 mg were given to the control group ,while ropivacaine 75 mg+ dexmedetemidine 1 .0 μg/kg were used in experimental group .The HR ,MAP , SpO2 ,Ramsay score at the time of entering the operating room (T0 ) ,brachial plexus anesthesia 10 min (T1 ) ,beginning of the operation (T2 ) ,30 min after the start of operation (T3 ) ,at the end of the surgery (T4 ) were compared in two groups ,while sensory and motor block work time ,length of time ,length of analgesia were recorded .Adverse effects were also observed and recorded .Results:The MAP ,HR at T1 ,T2 in experimental group were lower than those in T0 ,and lower than those in the control group significantly(P<0 .05) .The Ramsay score in experimental group was lower than that in the control group at each time point significantly (P<0 .05) .Sensory blockade working time ,motion block work time in experimental group were shorter than those in control group significantly (P< 0 .05) ,while the sensory blockade maintenance time ,motion block maintain time and duration time of analgesia in experimental group were longer than those in control group (P<0 .05) .There was no statistically significant differences in adverse effects between the groups .Conclusions :Dexmedetomidine combined with ropivacaine in ultrasound‐guided brachial plexus block can shorten onset time of local anaesthesia ,prolong the duration of sensory block ,motor block ,and duration of analgesia .