不同剂量右美托咪啶复合肋间神经阻滞在乳腺区段手术的疗效比较

目的：探讨不同剂量右美托咪啶复合肋间神经阻滞在乳腺区段手术中的安全性和有效性。方法：择期行乳房肿块区段切除术的患者120例。按年龄编号,采用完全随机化分组方式分为4组：单纯肋间神经阻滞组（INB组）;低、中、高剂量右美托咪啶复合肋间神经阻滞组（D1、D2、D3组）,D1、D2、D3组均予0.7μg·kg-1右美托咪啶负荷量后分别给予0.25μg·kg^-1·h^-10.5μg·kg^-1·h^-11μg·kg^-1·h^-1右美托咪啶维持量。观察并记录4组患者在肋间神经阻滞开始前（T0）,麻醉后30min（T1）、切皮时（T2）、手术中牵拉深部组织时（T3）、手术后1 h（T4）的平均动脉压（MAP）、心率（HR）、指脉搏氧饱和度（SPO2）、镇静评分（RAMSAY）、镇痛评分（VAS）等指标,并对总体麻醉效果进行评估。结果：D2、D3组在T1~T3时点上的MAP和HR明显低于INB组和D1组,但D3组心动过缓、低血压有明显发生（P〈0.05）。D2、D3组的术中（T2、T3）及术后（T4）时点的VAS评分低于INB组和D1组;RAMSAY评分D1、D2、D3组优于INB组,但D3组存在过度镇静现象（P〈0.05）。结论：0.5μg·kg^-1·h^-1持量的右美托咪啶复合肋间神经阻滞应用于乳腺区段手术镇静、镇痛更满意,呼吸、循环平稳,副作用少。

Dose Effect of Dexmedetomidine Combined with Intercostal Never Block in the Operation of Breast Section

Objective： To observe the efficacy and safety of combination of different dose of dexmedetomidine and intercostals never block in breast sectionn operation. Methods： By age number,using completely randomized grouping,patients were randomly divided into 4 groups： simple intercostal nerve block group（INB group） and low,medium and high dose of dexmedetomidine compound intercostal nerve block groups（D1,D2 and D3 group）,D1,D2,D3 groups were treated by 0.7 μg·kg-1dexmedetomidine as loading and 0.25 μg·kg^-1·h^-10.5 μg·kg^-1·h^-1nd 1 μg·kg^-1·h^-1s maintenance doses,respectively. To assess the effects,MAP,HR,SPO 2,RAMSAY,VAS circulation,respiration,sedation,analgesia and anesthesia overall indicators were monitored and recorded before intercostal nerve block（T0）,after 30 min of anesthesia（T1）,at the start of the skin incision（T2）,when stretching deep tissues during surgery（T3） and one hour after surgery（T4）. Results： MAP and HR in group D2,D3 were significantly lower than those in group INB and group D1 in time points T1,T2 and T3,but in group D3,bradycardia and hypotension happened more frequently（P0.05）. In D2 and D3 groups,VAS at time points T2,T3 and T4 of were lower than those in group INB and D1; D1,D2 and D3 groups were better than INB group in RAMSAY scoring,but group D3 showed the phenomenon of excessive sedation（P0.05）. Conclusion： The 0.5 μg·kg^-1·h^-1aintenance dose of dexmedetomidine compound intercostal nerve block can be applied to the breast section surgery sedation with more satisfied analgesia,smooth breathing and circulation and fewer side effects.