右美托咪啶用于罗哌卡因复合利多卡因腰丛联合坐骨神经阻滞的临床观察

发布时间：2018-04-29 17:05

本文选题：右美托咪啶 + 腰丛神经　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：观察右美托咪啶对于罗哌卡因复合利多卡因腰丛联合坐骨神经阻滞的影响,评估右美托咪啶复合罗哌卡因及利多卡因用于腰丛联合坐骨神经阻滞的麻醉效果及安全性。方法：选择大连医科大学附属第一医院择期行单侧大隐静脉高位结扎剥脱手术的患者26例,ASA（American Society of Anesthesiologists,美国麻醉医师协会）分级Ⅰ-Ⅱ级,年龄31-71岁,其中男性17例,女性9例。将患者随机分为实验组（D组）和对照组（R组）,每组各13例。入室后所有患者均予监测,面罩吸氧3L/分,并静脉给予芬太尼0.05mg,咪达唑仑1mg。两组患者由同一名麻醉医师行腰丛联合坐骨神经阻滞。实验组（D组）行腰丛神经阻滞给予0.25%罗哌卡因+0.5%利多卡因+右美托嘧啶0.5μ g/Kg共35ml,坐骨神经阻滞给予0.5%罗哌卡因+1%利多卡因+右美托嘧啶0.5μ g/Kg共15ml；对照组（R组）腰丛神经阻滞给予0.25%罗哌卡因+0.5%利多卡因共35ml,坐骨神经阻滞给予0.5%罗哌卡因+1%利多卡因共15ml。观察记录患者在麻醉穿刺前（T0）,麻醉完成后10分钟（T1）,手术开始时（T2）,麻醉完成后1小时（T3）,手术结束时（T4）的平均动脉压（MAP）,心率（HR）及血氧饱和度（SpO2）,记录腰丛及坐骨神经的感觉和运动阻滞起效时间及持续时间,观察术中出现的不良反应（如恶心呕吐,心动过缓等）并及时处理,术中如主诉疼痛给予芬太尼0.05mg静脉注射，，如疼痛难以忍受则改为全麻。结果：①术后随访所有患者均未发生不良反应或麻醉相关并发症,无一例改变麻醉方式,未出现恶心呕吐,D组中出现两例术中心率低于50次/分,经静脉给予阿托品0.4-0.8mg处理后好转,R组中1例患者主诉疼痛,予静脉分次追加芬太尼共0.15mg镇痛处理后顺利完成手术。②实验组于T1,T2,T3时间点测量的MAP值低于T0时所测值,实验组于T1,T2,T3时间点测量的HR值低于T0时所测量值,差异有统计学意义（P0.05或P0.01）；实验组于T1-T4测量HR与MAP值均低于对照组,差异有统计学意义（P0.05或P0.01）。③实验组腰丛神经及坐骨神经的感觉阻滞起效时间和运动阻滞起效时间与对照组无明显差异,实验组腰丛及坐骨神经的感觉阻滞持续时间和运动阻滞持续时间均长于对照组,差异有统计学意义（P0.01）。结论右美托咪啶加入罗哌卡因复合利多卡因用于腰丛联合坐骨神经阻滞是安全的,右美托咪啶可以延长腰丛联合坐骨神经的感觉及运动阻滞持续时间。
[Abstract]:Aim: to observe the effect of dexmetomidine on ropivacaine combined with lidocaine combined with sciatic nerve block and to evaluate the anesthetic effect and safety of dexmetomidine combined with ropivacaine and lidocaine for lumbar plexus combined with sciatic nerve block. Methods: 26 patients (age 31-71 years old, 17 males and 9 females) with ASA American Society of Anesthesiologists, (American Association of Anestheticists) were selected for selective exfoliation of unilateral great saphenous vein in the first affiliated Hospital of Dalian Medical University. The patients were randomly divided into experimental group D (n = 13) and control group (n = 13). All the patients were monitored, the 3L/ score of oxygen was absorbed by mask, and fentanyl 0.05 mg and midazolam 1 mg were given intravenously. The two groups were treated with lumbar plexus combined with sciatic nerve block by the same anesthesiologist. Group D (group D) received 0.25% ropivacaine 0.5% lidocaine 0.5 渭 g/Kg for 35 ml, sciatic nerve block 0.5% ropivacaine 1% lidocaine 0.5 渭 g/Kg for 15 ml, control group 1% ropivacaine 0.5% lidocaine 0.5 渭 g/Kg for 15 ml; control group 1% ropivacaine 0.5% lidocaine 0.5 渭 g/Kg The lumbar plexus nerve block was given 0.25% ropivacaine 0.5% lidocaine 35 ml and the sciatic nerve block 0.5% ropivacaine 1% lidocaine 15 ml. The mean arterial pressure (MAPP, HRT) and blood oxygen saturation (SPO _ 2) were recorded 10 minutes after anesthesia, 10 minutes after anesthesia, 1 hour after anesthesia, and at the end of operation. The data of lumbar plexus and sciatic nerve were recorded. Onset and duration of sensory and motor block, Adverse reactions (such as nausea, vomiting, bradycardia, etc.) were observed and treated in time. Fentanyl 0.05mg was given intravenously during the operation, and if the pain was unbearable, it was changed to general anesthesia. Results there were no adverse reactions or anaesthesis-related complications in all the patients followed up after 1: 1, and no change in anaesthesia. In group D, the rate of operation center was less than 50 times in group D with no nausea and vomiting. After intravenous administration of atropine 0.4-0.8mg, one patient in group R complained of pain. After intravenous administration of fentanyl combined with 0.15mg analgesia, the MAP value of experimental group was lower than that of T0 group at T _ (1) T _ (2) T _ (3). The HR value of the experimental group was lower than that of the T0 group at T _ 1 / T _ 2 T _ 3 time point, the difference was statistically significant (P 0.05 or P 0.01), and the HR and MAP values of the experimental group were lower than those of the control group at the time point of T _ 1 and T _ 2T _ 3. There was no significant difference in the onset time of sensory block and motor block of lumbar plexus nerve and sciatic nerve between the experimental group and the control group. The duration of sensory block and motor block of lumbar plexus and sciatic nerve in experimental group was longer than that in control group (P 0.01). Conclusion it is safe to use dexmetomidine plus ropivacaine combined with lidocaine for lumbar plexus combined with sciatic nerve block. Dexmetomidine can prolong the duration of sensory and motor block of lumbar plexus combined with sciatic nerve.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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