右美托咪定复合罗哌卡因在超声引导下臂丛神经阻滞的应用

目的观察右美托咪定复合罗哌卡因在超声引导下臂丛神经阻滞的临床效果。方法选择南京大学医学院附属鼓楼医院择期行前臂桡侧手术患者40例,均为美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级。将患者随机分为对照组及实验组,每组各20例。患者均行超声引导下肌间沟臂丛神经阻滞。实验组给予罗哌卡因75 mg＋右美托咪定1μg/kg,对照组给予罗哌卡因75 mg。观察入室时（T0）、臂丛麻醉后10 min（T1）、手术开始时（T2）,手术开始后30 min（T3）、手术结束时（T4）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）和警觉/镇静（OAA/S）评分;记录感觉和运动阻滞起效时间、持续时间,镇痛持续时间;观察并记录不良反应。结果①实验组T1、T2时间点MAP（76±6）、（76±5）mm Hg]低于T0（82±8）mm Hg],T1～4时间点HR（72±6）、（72±6）、（75±8）、（75±7）次/min]低于T0（81±8）次/min],差异有统计学意义（P〈0.05或P〈0.01）;实验组T1、T2时间点HR低于对照组,差异有统计学意义（P〈0.05或P〈0.01）。②实验组在感觉阻滞起效时间（9±2）min]、运动阻滞起效时间（12±1）min]、感觉阻滞维持时间（623±148）min]、运动阻滞维持时间（566±130）min]均低于对照组（10±2）、（13±2）、（465±105）、（412±85）min],镇痛持续时间（572±137）min]长于对照组（756±225）min],差异均有统计学意义（P〈0.05或P〈0.01）。③实验组OAA/S评分在T1～4时间点均低于对照组,差异有统计学意义（P〈0.05）。两组不良反应发生率比较差异无统计学意义（P〉0.05）。结论右美托咪定复合罗哌卡因应用于超声引导下臂丛阻滞,可缩短感觉、运动阻滞起效时间,延长感觉、运动阻滞持续时间及镇痛持续时间。

Application of dexmedetomidine combined with ropivacaine in ultrasound-guided brachial plexus block

Objective To observe the clinical effect of dexmedetomidine combined with ropivacaine in ultrasoundguided brachial plexus block. Methods 40 patients in Affiliated Drum-Tower Hospital of Medical College of Nanjing University with ASA Ⅰ-Ⅱ, undergoing elective forearm surgery were selected and divided into experimental group and control group with 20 cases in each group. All persons were received the interscalene brachial plexus block guided by ultrasound. Ropivacaine 75 mg＋dexmedetemidine 1 μg/kg were used in experimental group, ropivacaine 75 mg were given to control group. HR, MAP, SpO2, OAA/S score at the time of entering the operating room （To）, brachial plexus anesthesia 10 min （T1）, beginning of the operation （T2）, 30 min after the start of operation （T3）, at the end of the surgery （T4） were observed; sensory and motor block work time, length of time, length of analgesia were recorded; untoward effect were observed and recorded. Results ①MAP in Th T2 time point in experimental group （76±6）, （76±5） mm Hg] were lower than those in To time point （82±8） mm Hg], HR in T1-4 time point in experimental group （72±6）, （72±6）, （75±8）, （75±7） times/min] were lower than those in To time point （81±8） time/min], the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. ②Sensory blockade working time, motion block work time, sensory blockade maintenance time, motion block maintain time in experimental group （9±2） min, （ 12±1 ） min, （623±148 ） min, （566±130） mini were lower than those in control group （10±2）, （13±2）, （465±105）, （412±85） min], duration time of analgesia in experimental group （572±137） min] was longer than that in control group （756±225） mini, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. ③OAA/S score in T1-4 time point in experimental group were lower than those in control group, the differences were statistically significant （P 〈 0.0l）. The differences of the rate of untoward effect was not statistically significant （P 〉 0.05）. Conclusion Dexmedetomidine combined with ropivacaine in uhrasound-guided brachial plexus block can shorten onset time of sensory block and motor block, prolong the duration of sensory block and motor block and duration of analgesia.