罗哌卡因复合右美托咪定经超声引导锁骨上臂丛阻滞在肩周关节松解术中的应用

摘要

目的 探讨罗哌卡因复合右美托咪定经超声引导下锁骨上臂丛神经阻滞在肩周关节松解术中的应用.方法 选择本院2013年5月至2016年5月在超声引导锁骨上臂丛神经阻滞下行双侧肩关节松解术的60例患者为研究对象,按照随机数表法将入选患者分为A、B、C三组,每组各20例.A组患者给予罗哌卡因阻滞,B组患者给予含右美托咪定的罗哌卡因阻滞,C组患者在罗哌卡因阻滞的同时静脉注射右美托咪定.比较各组患者臂丛神经阻滞情况、术中生命体征及术后镇痛情况.结果 三组患者臂丛神经感觉阻滞起效时间和运动阻滞起效时间比较均无显著差异(P>0.05),但三组患者感觉阻滞持续时间和运动阻滞持续时间比较均有显著差异(P<0.05),且B组患者阻滞持续时间最长.A组和B组患者麻醉前(T1)、阻滞后10分钟(T2)、手术开始即刻(T3)、术毕(T4)4个时间点的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)比较均无显著差异(P>0.05);T2和T3时间点,C组患者HR和MAP较T1时间点均显著降低,且显著低于同期A组和B组水平(P<0.05).三组患者上述4个时间点血氧饱和度(blood oxygen saturation,SpO2)比较均无显著差异(P>0.05).三组患者术后镇痛持续时间和术后镇痛药物使用率比较均具有显著差异(P<0.05),B组患者镇痛时间最长、术后镇痛药物使用率最低.结论 在超声引导锁骨上臂丛神经阻滞下应用罗哌卡因复合右美托咪定,能够有效延长感觉阻滞时间、运动阻滞持续时间及术后镇痛持续时间,降低术后镇痛药物使用率,且对患者的血压和心率影响较小.%Objective To investigate the application of Ropivacaine combined with Dexmedetomidine in the joint mobilization for bilateral shoulderby ultrasound-guided supraclavicular brachial plexus block. Method From May 2013 to May 2016, 60 patients underwent joint mobilization for bilateral shoulderby ultrasound-guided supraclavicular brachial plexus block were selected as the subjects. According to the random number table, the patients were divided into group A, group B and group C, each group of 20 cases. Patients in group A were blocked with Ropivacaine alone. Patients in group B were blocked with Ropivacaine containing Dexmedetomidine. Patients in group C were blocked with Ropivacaine and Dexmedetomidine injected intravenously at the same time. The condition of brachial plexus block, intraoperative vital signs and postoperative analgesia were compared among each group. Result There were no significant differences inthe onset time of neural sensory block and the time of onset of exercise block among the three groups (P >0.05). But there were significant differences in the duration of sensory block and the duration of exercise block among the three groups (P < 0.05), patients in group B had the longest duration. There were no significant differences for rate of heart rate (HR) and mean arterial pressure (MAP) before anesthesia (T1), 10 minutes after blocked (T2), the beginning of operation (T3) and after operation (T4) in group A and group B (P > 0.05). In group C, HR and MAP at T2 and T3 were significantly lower than those at T1, and were significantly lower than those in group A and group B at the same time points (P < 0.05). There were no significant differences in blood oxygen saturation (SpO2) among the three groups at each time points (P > 0.05). There were significant differences in inpostoperative analgesic duration and the rate of postoperative analgesic drug use among the three groupss (P < 0.05). In group B, the postoperative analgesic duration was the longest, and the rate of postoperative analgesic drug use was the lowest. Conclusion The use of ropivacaine combined with dexmedetomidine in ultrasound-guided supraclavicular brachial plexus block can prolong the duration of sensory block, duration exercise block, and duration of postoperative analgesia, and reduce the rate of postoperative analgesic druguse, with little impact on the patient's blood pressure and heart rate.