右美托咪定在臂丛神经阻滞麻醉中的应用

目的探讨右美托咪定用于辅助臂丛神经阻滞麻醉的效果。方法 60例上肢手术患者随机分为2组,每组30例,均选用肌间沟臂丛神经阻滞。穿刺找到异感后注射0.375%罗哌卡因10mL+1%利多卡因10mL局部麻醉,15min后麻醉效果确定、切皮无疼痛感后,试验组10min内静脉泵注右美托咪定1μg·kg~(-1),后以0.5μg·kg~(-1)·h~(-1)维持30min;对照组则静脉注射氟芬合剂2mL(含氯哌利多2.5mg和芬太尼0.05mg)。记录不同时点患者的心率、血氧饱和度(SpO_2)、呼吸频率,并进行OAA/S镇静评分。结果 2组给药后,各时点OAA/S评分均降低,与给药前相比差异显著(P<0.05),停药后20min试验组OAA/S评分高于对照组(P<0.05)。试验组患者用药后心率减慢(P<0.05),对照组无明显变化。试验组患者给药及维持期间SpO_2、呼吸频率无明显变化,对应时点对照组患者5pO_2、呼吸频率有所下降,2组差异显著(P<0.05)。2组术后均无发生恶心、呕吐,患者对术中评价满意。结论右美托咪定用于臂丛神经阻滞麻醉,对清醒患者有明显镇静效应并可被唤醒,无呼吸抑制情况,但会使患者心率减慢。

Effects of dexmedetomidine in brachial plexus block anesthesia

AIM To investigate the effects of dexmedetomidine in brachial plexus block anesthesia. METHODS Sixty patients undergoing brachial plexus block anesthesia were randomly divided into two groups (30 patients in each group).The patients in both groups were injected with 0.375%ropivacaine 10 mL and 1% lidocaine 10 mL.After the onset time that the targeted arm was fully anesthetized,the patients in the trial group received a loading dose of dexmedetomidine 1μg·kg~(-1) within ten minutes and the continuous infusion was 0.5μg·kg~(-1)·h~(-1) for thirty minutes.The patients in the control group were administered with droperidol-fentanyl 2 mL(droperidol 2.5 mg,fentanyl 0.05 mg).Heart rate(HR),oxygen saturation(SpQ2),respiratory rate and the Observer's Assessment of Alertness/Sedation(OAA/S) were recorded.RESULTS Both groups provided significantly sedative effect and the OAA/S score significantly declined(P<0.05).At twenty minutes after stopping infusion,the OAA/S score in the trial group was higher than that in the control group.The HR in the trial group was slowed down after the loading dose and no change in the control group.The SpO_2 and respiratory rate of the control group were lower than those of the trial group during the maintenance period(P<0.05).No postoperative nausea and vomiting were observed in both groups,and all patients reported satisfaction with the procedure.CONCLUSION In brachial plexus block anesthesia,dexmedetomidine has sedative effect and the patients can be aroused.It can decrease HR but no respiratory depression.