右美托咪定联合罗哌卡因对臂丛神经阻滞效应的影响

摘要

目的 观察右美托咪定对罗哌卡因臂丛神经阻滞效应的影响.方法 择期臂丛神经阻滞下行前臂或手部手术的患者40例,ASA分级Ⅰ或Ⅱ级,随机分为两组(n=20),罗哌卡因组(R组):神经阻滞用药为0.375％罗哌卡因20 ml+生理盐水1 ml；右美托咪定复合罗哌卡因组(D组):神经阻滞用药为0.375％罗哌卡因20 ml+右美托咪定混和液100μg.观察注药前5 min (T0)、注药后3 min(T1)、5min(T2)、10 min (T3)、15 min (T4)、20 min (T5)、30 min (T6)各时点SBP、DBP、HR和SpO2的变化；评价感觉阻滞和运动阻滞的效果,记录感觉阻滞和运动阻滞起效时间、持续时间、镇痛维持时间、麻醉质量和肌松质量、术中疼痛评分；同时记录术中寒战、低血压、嗜睡等不良反应发生情况.结果 无一例患者使用补救用药或者更改麻醉方式,所有患者均未发生寒战、低血压、嗜睡等并发症.T1、T2、T3、T4、T5和T6各时点SBP、DBP、HR和SpO2组间差异无统计学意义；与R组相比较,D组感觉阻滞起效时间短、持续时间长(P＜0.05),运动阻滞起效时间短(P＞0.05)、持续时间长(P＜0.05),镇痛维持时间无明显变化；麻醉质量、肌松质量和不良反应发生情况组间比较差异无统计学意义.结论 右美托眯定复合罗哌卡因用于臂丛神经阻滞能增强罗哌卡因的麻醉效应,起效加快、维持时间延长,且无严重不良反应发生.%Objective To evaluate the effect of dexmedetomidine combined with ropivacaine on brachial plexus block. Methods Forty patients with ASA Ⅰ or Ⅱ, scheduled for elective forearm and hand surgery, were randomly divided into two equal groups. In group R (n=20), patients were given 20 ml (75 mg) of 0.375% ropivacaine-1 mL saline, while in group D (n=20), patients were treated with 20 ml (75 mg) of 0.375% ropivacaine+1 ml dexmedetomidine. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and SpO2 at 5 min before anesthesia (T0), 3 min (T1)、5 min(T2)、10 min (T3)、15 min (T4)、20 min (T5)、30 min (T6) after anesthesia were investigated. Motor and sensory block onset times, block durations, and duration of analgesia were recorded. The score of pain in operation and the adverse effects of shiver, hypopiesia, drowsiness and blood loss were recorded during operation. Results No case needed to be treated with rescue analgesics or change of anesthesia. No complications (such as shiver, hypopiesia, drowsiness) occurred in all the patients. Levels of SBP, DBP, HR and SpO2 at T1 T2, T3、T4、T5 and T6 showed no statistically significant difference between the two groups. Motor and sensory block onset times in group D were significantly shorter than that in group R (P<0.05), with significantly longer block durations (P< 0.05). Duration of analgesia, quality of analgesia, and adverse effects showed no statistically significant difference between the two groups. Conclusion Dexmedetomidine combined with ropivacaine for brachial plexus block shortens the onset time and prolongs the duration of the block, with no severe adverse reactions.