右美托咪定复合芬太尼辅助臂丛阻滞麻醉的临床观察

摘要

Objective:To explore the clinical effects of dexmedetomidine and fentanyl assisted interscalene branchial plexus block on the upper limb operation. Methods: 36 patients with upper limb surgery were randomly divided into A group and B group. Patients of A group were administered with ropivacaine (0.375%)+fentanyl(10 μg/mL) and patients of B group were ad-ministered with ropivacaine(0.375%)+fentanyl(10 μg/mL)+dexmedetomidine(1 μg/kg). The heart rate(HR), mean arterial pres-sure(MAP), pulse oxygen saturation(SpO2) and observer’s assessment of alertness/sedation(OAA/S) were recorded at pre-anethesia(T0), surgery beginning(T1), post-surgery 30 min(T2) and the end of surgery(T3) four time point. The onset time of anesthesia, analgesia duration and exercise recovery time were recorded. Results: Compared with group A, HR and MAP of patients in the group B reduced significantly and OAA/S score dcreased at T1 , T2 and T3. The difference was statistically significant(P<0.05). Compared with group A, the onset time of anesthesia in group B decreased, analgesia duration and exer-cise recovery time in group B prolonged. The difference was statistically significant(P<0.05). The difference about adverse reactions ( bradycardia , respiratory depression , nausea and vomiting ) between two groups was not statistically significant ( P>0 . 05 ) . Conclusion:Dexmedetomidine and fentanyl assisted brachial plexus anesthesia can significantly shorten onset time of anesthesia, prolong duration of analgesia.%目的：探讨右美托咪定复合芬太尼辅助肌间沟臂丛阻滞麻醉的临床效果。方法：将36例择期臂丛麻醉下行上肢手术患者随机分为A组和B组：A组以0.375%罗哌卡因+芬太尼(10μg/mL)共20 mL行肌间沟臂丛阻滞麻醉；B组以0.375%罗哌卡因+右美托咪定(1μg/kg)+芬太尼(10μg/mL)共20 mL行肌间沟臂丛阻滞麻醉。在麻醉前(T0)、手术开始时(T1)、手术30 min时(T2)和手术结束时(T3)4个时间点记录患者心率(heart rate，HR)、平均动脉压(mean arterial pres-sure，MAP)、血氧饱和度(pulse oxygen saturation，SpO2)，警觉/镇静评分(observer’s assessment of alertness/sedation，OAA/S)，并记录两组患者麻醉起效时间、镇痛持续时间、运动恢复时间。结果：与A组比较，B组在T1、T2、T3时HR、MAP显著降低；B组在T1、T2、T3时OAA/S评分较低；B组麻醉起效时间缩短，镇痛持续时间和运动恢复时间延长(P<0.05)。心动过缓、呼吸抑制、恶心及呕吐等不良反应差异无统计学意义(P>0.05)。结论：右美托咪定复合芬太尼辅助臂丛阻滞麻醉可明显缩短麻醉起效时间，延长镇痛时间。