右美托咪啶复合臂丛神经阻滞在30例断指再植术中的应用

目的比较右美托咪啶(Dex)和丙泊酚复合臂丛麻醉在断指再植术中对患者镇静和循环、呼吸的影响。方法选择美国麻醉医师学会(ASA)根据病情分级为Ⅰ～Ⅱ级的急诊断指再植术患者60例,随机分为两组,各30例,Dex组:负荷量1.0μg/kg微量泵15min注入,后给予维持量0.5μg/(kg.h);丙泊酚组按血浆靶浓度1～2μg/mL靶控输注丙泊酚。比较两组用药后的循环、呼吸和镇静Ramsay评分效果。结果给药后各时点丙泊酚组的平均动脉压(MAP)、心率(HR)和呼吸频率(RR)均有明显下降趋势(P<0.05);而Dex组仅HR和RR出现明显下降,但RR仍高于同时点的丙泊酚组(P<0.05)。丙泊酚组和Dex组患者镇静(Ramsay评分)效果比较差异无统计学意义(P>0.05)。结论 Dex静脉镇静效果确切,没有明显的循环和呼吸抑制作用,是臂丛神经阻滞的合理辅助用药。

Application of dexmedetomidine combined anesthesia with brachial plexus block on finger replantation surgery in 30 cases

Objective To compare the influence of dexmedetomidine(Dex)and propofol combined anesthesia with brachial plexus block on sedation and the respiratory-circular function in finger replantation surgery.Methods Sixty patients with grade ASA Ⅰ-Ⅱ emergency finger replantation were randomly divided into two groups,30 cases in each group.The Dex group:loading dose Dex 1.0 μg/kg was injected within 15 min as bolus,and 0.5 μg/(kg·h)maintained.The propofol group:1-2 μg/mL concentrations of propofol target-controlled infusion.The respiratory,circulatory functions and sedation(Ramsay scores)were evaluated at the timepionts before nerve block(T0),after nerve block(T1),10 min(T2),30 min(T3),60 min(T4)and 120 min(T5)during surgery.Results The mean arterial pressure(MAP),heart rate(HR)and respiratory rate(RR)showed a descending trend on all timepionts after administration in the propofol group(P<0.05).Only MAP and HR presented a descending trend in the Dex group(P<0.05),but nor with RR(P>0.05);RR present significant higher in the Dex group compared with the propofol group(P<0.05).There was no difference in the sedation scores between two groups.Conclusion Intravenous Dex shows an exact sedating effect after administration without significant respiratory and circulatory inhibitory effect during anesthesia process.Therefore,dexmedetomidine is a reasonable adjuvant drug on brachial plexus nerve block.