右美托咪定联合喷他佐辛用于臂丛神经阻滞的效果观察

目的:观察右美托咪定联合喷他佐辛用于臂丛神经阻滞的临床疗效。方法:选取需行上肢手术的病人60例，随机分为单纯臂丛组（D组），右美托咪定+臂丛组（G1组），喷他佐辛+臂丛组（G2组），右美托咪定+喷他佐辛+臂丛组（G3组），每组15例。D组注射0.375%罗哌卡因20 mL，G1组注射0.375%罗哌卡因+0.5 μg/kg右美托咪定混合液20 mL，G2组注射0.375%罗哌卡因+0.5 mg/kg喷他佐辛混合液20 mL，G3组注射0.375%罗哌卡因+0.5 μg/kg右美托咪定+0.5 mg/kg喷他佐辛混合液20 mL。记录各组麻醉前、手术开始5、10、30、60 min的平均动脉压、心率（HR）、血氧饱和度；记录各组感觉起效时间、痛觉消失持续时间；观察病人是否有镇痛不全及更改麻醉方式；记录病人术后6 h的视觉模拟评分和Ramsay评分。结果:手术开始5、10、30、60 min时平均动脉压G3组0.05）。G1、G2、G3组病人的感觉阻滞起效时间及痛觉消失持续时间均短于D组（P < 0.01）；感觉阻滞起效时间G3组短于G1组（P<0.01）；痛觉消失持续时间G3组长于G1组与G2组（P < 0.01）。4组病人镇痛不全及更改麻醉方式发生情况差异均无统计学意义（P>0.05）。术后6 h，G3组病人视觉模拟评分和Ramsay评分均明显低于D组、G1组及G2组（P<0.01），其余3组间差异均无统计学意义（P>0.05）。结论:右美托咪定联合喷他佐辛用于臂丛神经阻滞麻醉，能够增强臂丛神经阻滞麻醉的镇静、镇痛效果，利于病人术后的快速康复。

Application effect of dexmedetomidine combined with pentazocine in brachial plexus block

Objective: To investigate the effects of dexmedetomidine combined with pentazocine in the application of brachial plexus block.Methods: Sixty patients scheduled by operation were randomly divided into the simple brachial plexus group(D group),dexmedetomidine + brachial plexus group(G1 group),pentazocine + brachial plexus group(G2 group),and dexmedetomidine + spray pentazocine + brachial plexus group(G3group)(15 cases each group).D group was injected with 20 mL of 0.375% ropivacaine,G1 group was injected with 20 mL mixture of 0.375% ropivacaine and 0.5 μg/kg dexmedetomidine,G2 group was injected with 20 mL mixture of 0.375% ropivacaine and 0.5 mg/kg pentazocine,and G3 group was injected with 20 mL mixture of 0.375% ropivacaine,0.5 μg/kg dexmedetomidine and 0.5 mg/kg pentazocine.The MAP,HR and SpO₂ in four groups before anesthesia and after 5,10,30,and 60 min of operation were recorded.The onset time of sensation and duration of pain disappearance were recorded.The patients with incomplete analgesia and changing anesthesia mode,and postoperative 6 h VAS score and Ramsay score in four groups were observed.Results: At postoperative 5,10,30 and 60 min,the MAP vlaues in G3,G2,G1 and D groups gradually increased,and the difference of which was statistically significant(P<0.01).At postoperative 5 and 10 min,the HR values in G2 and G3 groups were significantly lower than that in D group(P<0.05 and P<0.01).At postoperative 30 and 60 min,the HR values in G3,G2,G1 and D groups gradually increased,and the difference of which was statistically significant(P<0.01 to P<0.05).The differences of SpO₂ values among four groups at all time-points were not statistically significant(P>0.05).The onset time of sensory block and duration of pain disappearance in G1,G2 and G3 groups were shorter than those in D group(P<0.01).The onset time of sensory block in G3 group was shorter than that in G1 group(P<0.01).The duration of pain disappearance in G3group was longer than that in G1 and G2 group (P<0.01).There was no statistical significance in the incidence rate of incomplete analgesia and changing anesthesia mode among four groups(P>0.05).At postoperative 6 h,the VAS score and Ramsay score in G3 group were significantly lower than that in D,G1 and G2 groups(P<0.01),and the differences of which among D,G1 and G2 groups were not statistically significant(P>0.05).Conclusions: The dexmedetomidine combined with pentazocine in the application of brachial plexus block anesthesia can enhance the sedative and analgesic effects,and is beneficial to the rapid recovery of postoperative patients.