右美托咪定不同途径给药对罗哌卡因腰丛-坐骨神经联合阻滞效果的影响

目的 评价右美托咪定(dexmedetomidine,Dex)不同途径给药方式对0.375％罗哌卡因腰丛挫骨神经联合阻滞(combined lumber plexus and sciatic nerve block,CLPSNB)效果的影响. 方法 90例CLPSNB患者按随机数字表法分为3组(每组30例):罗哌卡因组(R组),0.375％罗哌卡因50 ml行CLPSNB;罗哌卡因+Dex静脉注射组(D+R组),静脉输注Dex 1 μg/kg(输注时间10 min)同时0.375％罗哌卡因50 ml行CLPSNB;罗哌卡因局部麻醉药液混合Dex组(DR组),局部麻醉药Dex 1 μg/kg+0.375％罗哌卡因至50 ml行CLPSNB.R组和DR组同时静脉输注与D+R组相同容量的生理盐水.记录感觉阻滞和运动阻滞的起效时间和维持时间、术者的满意情况及副作用发生情况. 结果 3组感觉阻滞和运动阻滞的起效时间差异无统计学意义(P＞0.05);运动阻滞持续时间和首次使用镇痛药的时间DR组[(768±246) min和(1 080±300) min]、D+R组[(732±204) min和(1 050±288) min]显著长于R组[(420±126) min和(840±306) min] (P＜0.05);感觉阻滞持续时间DR组[(1008±258) min]显著长于R组[(624±216) min]、D+R组[(672±144) min](P＜0.05),而R组与D+R组比较,差异无统计学意义(P＞0.05).术者满意率DR组(100％)高于R组(85％)(P＜0.05).3组患者均未出现恶心、呕吐、低血压、呼吸抑制等副作用. 结论 Dex混合于0.375％罗哌卡因行CLPSNB麻醉效果及术者满意度佳.

Effect of dexmedetomidine given by different routes on combined lumbar plexus and sciatic nerve block with ropivacaine

Objective To evaluate the effect of dexmedetomidine (Dex) given by different routes on combined lumbar plexus and sciatic nerve block (CLPSNB) with 0.375％ ropivacaine.Methods Ninety patients were randomly allocated into three groups (n=30):0.375％ ropivacaine 50 ml for CLPSNB in group R,1 μg/kg Dex infused over 10 min+0.375％ ropivacaine 50 ml for CLPSNB in group D+R,and 1 μg/kg Dex diluted in 0.375％ ropivacaine 50 ml for CLPSNB in group DR.Groups R and DR were intravenously infused with the same volume of saline in group D+R.The onest time and duration of sensory and motor block,satisfaction of doctors,and side effects were recorded.Results Sensory and motor block onset time has no significant difference among three groups (P＞0.05).Motor block duration and first time use of analgesics were longer in group DR[(768±246) min and (1 080±300) min] and group D+R [(732±204) nin and (1 050±288) min] than group R[(420±126) min and (840±306) min](P＜0.05).Sensory block duration was longer in group DR [(1 008±258) min] than group D+R [(672±144) min](P＜0.05),while there was of no significance between groups R and D+R.The satisfaction of doctors was better in group DR (100％) than group R (85％)(P＜0.05).No complications occurred in all patients (P＞0.05).Conclusions Dex diluted in 0.375％ ropivacaine for CLPSNB can provide good analgesic efficacy and satisfaction of doctors.