右美托咪定和咪达唑仑辅助肌间沟臂丛神经阻滞的比较

目的比较臂丛神经阻滞中右美托咪定和咪达唑仑的镇静效果及不良反应。方法 80例择期行上肢手术的患者随机分成右美托咪定组(D组)和咪达唑仑组(M组),在超声引导下以0.375%罗哌卡因30 mL行臂丛神经阻滞,麻醉效果满意后开始镇静,分别予右美托咪定1.0μg.kg-1及咪达唑仑0.1 mg.kg-1。观察2组麻醉前(T0)、开始镇静时(T1)、输注镇静药后15 min(T2)、切皮后30 min(T3)、手术结束时(T4)生命体征变化。记录2组镇静起效时间、效果和持续时间,并观察2组不良反应发生情况。结果 T2、T3时,2组患者血压、心率及M组脉搏血氧饱和度(SpO2)均较T1时降低(P<0.05),D组SpO2无显著变化。D组镇静起效时间短于M组(P<0.05),镇静深度D组集中于Ⅲ级,而M组多分布于Ⅱ级及Ⅵ级,D组满意率高于M组且镇静持续时间长于M组(P<0.05)。D组不良反应主要为术中心动过缓和术后头晕,而M组多见呼吸抑制和术后头晕,不良发生率D组(25%)低于M组(48%,P<0.05)。结论右美托咪定较咪达唑仑更适用于臂丛神经阻滞中镇静。

Comparison of dexmedetomidine and midazolam administered in aid interscalene brachial plexus nerve block

AIM To compare the sedative effect and adverse reactions of dexmedetomidine and midazo-lam in aid interscalene brachial plexus nerve block.METHODS Eighty patients undergoing upper limb surgery were randomly divided into 2 groups with 40 for each.The patients in both groups were injected with 0.375% ropivacaine 30 mL by ultrasonic guidance.After the satisfactory anaesthesia effect attained,the patients in the dexmedetomidine group(group D)and midazolam group(group M)received dexmedetomidine 1.0 μg·kg-1 and midazolam 0.1 mg·kg-1 respectively.The patients’vital signs were recorded before anaesthesia(T0),at sedation beginning(T1),15 min after injection of sedatives(T2),30 min after skin incision(T3)and the operation completed(T4).The onset time of sedation,duration of effects and the occurrence of adverse reactions were observed.RESULTS The patients’blood pressure,heart rate in both groups and pulse oxygen saturation(SpO2)in the group M at T2,T3 were decreased compared with those at T0(P < 0.05).While the SpO2 in the group D showed no obvious changes.The onset time of sedation in the group D was shorter compared with that in the group M(P < 0.05).The sedation deepness in the group D centralized at grade Ⅲ in the group D,while distributed by grade Ⅱor Ⅵ in the group M.The satisfaction rate in the group D was higher than that in the group M(P < 0.05).The continued sedation time in the group D was longer than that in the group M(P < 0.05).Intraoperative bradycardia and post-surgery dizziness were major adverse reactions in the group D.Dizziness and postoperative respiratory depression were mainly seen in the group M.The adverse reaction rate of group D(25%)was lower than that in the group M(48%,P < 0.05).CONCLUSION Sedation with dexmedetomidine in aid intersclance brachial plexus block anesthesia is more suitable than midazolam.