右美托咪啶复合罗哌卡因对肌间沟臂丛阻滞效果及脑电双频指数的影响

摘要

目的 探讨盐酸右美托咪啶(DEX)复合罗哌卡因对肌间沟臂丛神经阻滞效果及脑电双频指数(BIS)的影响.方法 选取拟行肌间沟臂丛神经阻滞的上臂手术患者145例作为研究对象,采用随机数字表法分为4组,对照组D组(n=36),给予0.5％罗哌卡因20ml+安慰剂,观察组采用罗哌卡因与右美托咪啶混合液,其中观察组A组(n=36)给予0.5％罗哌卡因20ml+1ug/kg右美托咪啶,B组(n=37)为0.375％罗哌卡因20ml+1ug/kg右美托咪啶,C组(n=36)为0.5％罗哌卡因20ml+0.5ug/kg右美托咪啶,对比4组患者臂丛神经阻滞效果及BIS.结果 与对照组D组比较,观察组A、B、 C组三组镇痛起效时间和A组、C组运动阻滞起效时间均明显缩短(P＜0.05),B组运动阻滞起效时间比对照D组缩短,但无明显差异(P＞0.05);观察A组镇痛、运动阻滞起效时间均明显短于B组、C组(P＜0.05);观察A、B、C组运动恢复时间与镇痛持续时间与对照D组相比均延长(P＜0.05),且A组镇痛时间最长(P＜0.05);对照D组BIS值均在90以上,且在 T1-T5期间无明显变化;A、B、C、D四组在T0时组间比较BIS值无显著性差异(P＞0.05);在T1-T5时观察A、B、C组BIS值均较T0时显著下降(P＜0.05),与同一时刻对照D组相比差异有统计学意义(P＜0.05);T3时,A、B、C三组BIS值均较 T1,T2时有所回升;T5时A、B、C三组BIS值均明显回升(P＜0.05);A组TI-T4时BIS值均低于B、C组,差异有统计学意义(P＜0.05).结论 右美托咪定复合罗哌卡因应用于肌间沟臂丛阻滞麻醉能够缩短麻醉起效时间,延长作用时间及术后镇痛时间,并具有镇静效果,有一定临床应用价值.%Objective To explore the influence of Dexmedetomidine(DEX) combined with ropivacaine on interscalene brachial plexus block effect and Bispectral Index(BIS). Methods 145 cases of arm surgery patients undergoing brachial plexus block in our hospital were selected as the study group, and were divided into four groups according to random number table method. The control group D group (36 cases) were given 0. 5％ ropivacaine 20ml+placebo. The experimental groups were a mixture of ropivacaine and dexmetomidine. A group (n=36) were given 0. 5％ ropivacaine 20ml+1ug/kg dexmedetomidine, B group(n=37) were given 0. 375％ ropivacaine 20ml+1ug/kg dexmedetomidine, and C group (n=36) were given 0.5％ ropivacaine 20ml+0. 5ug/kg dexmedetomidine. The effect of brachial plexus block and BIS were contrasted in the four groups. Results Compared with group D, it were significantly shorter(P＜0.05) that the onset time of sensory block in group A, B, C and onset time of the motor block in group A, C'but there was no significant difference in onset time of motor block in the group B (P＞0. 05) though it was shorter. The onset time of the sensory block and the motor block in the group A was significantly shorter than that of the B and C groups (P＜0. 05). Sensory and motorial recovery time of group A, B and C were longer than those of group D (P＜0. 05), and the duration of analgesia in group A was longest. The BIS of group D was above 90 scores without significant changes in T1-T5 period, and there was no statistically significant difference when compared with that at T0 in the all groups (P＞0. 05). Compare with T0, the BIS of T1, T2, T3, T4 and T5 in the A, B and C groups decreased significantly (P＜0. 05), and there was statistically significant difference when compared with that at the same time in the group D(P＜0. 05). At T3, BIS in the A, B, C groups were slightly higher than those of T1 and T2, but at T5, the increase of BIS in the A, B, C groups were significant (P＜0. 05). The BIS of TI-T5 in group A were lower than those in group B and C, the difference was statistically significant (P＜0. 05). Conclusion Dexmedetomidine combined with ropivacaine can shorten the onset time of interscalene brachial plexus block anesthesia and prolongs the duration of the block and the duration of postoperative analgesia. It get sedative effect, but the sedative effect affected by external factors.