臂丛神经阻滞麻醉下右美托咪定静脉给药对止血带引起疼痛的预防效果

发布时间：2018-07-30 08:36

【摘要】：目的评价臂丛神经阻滞麻醉下小剂量右美托咪定静脉给药对止血带引起疼痛的预防效果。方法选择美国麻醉医师协会分级Ⅰ至Ⅲ级、择期行上肢手术的患者40例,采用随机数字表法将其分入右美托咪定组和对照组,每组20例。所有患者均于神经刺激器引导下行臂丛神经阻滞麻醉。右美托咪定组患者臂丛注射1%利多卡因10mL(内含右美托咪定50μg)+0.375%罗哌卡因25mL,止血带充气后缓慢静脉注射右美托咪定50μɡ;对照组臂丛注射1%利多卡因10mL(不含右美托咪定)+0.375%罗哌卡因25mL,止血带充气后静脉注射等量的0.9%氯化钠溶液。止血带充气压力均为200~250mmHg(1mmHg=0.133kPa),压迫时间90min。记录所有患者止血带充气压迫后30、60、90min时的疼痛视觉模拟评分(VAS评分),记录麻醉前、手术开始前,以及手术开始后15、30、60min时患者的Ramsay镇静评分。观察患者的止血带耐受情况、心血管不良事件和其他不良反应的发生情况。结果右美托咪定组在止血带充气压迫后30、60、90min的疼痛VAS评分分别为(0.8±0.6)、(2.1±1.6)、(3.1±1.7)分,分别显著低于对照组的(2.7±2.0)、(4.2±2.0)、(5.8±2.5)分(P值均0.05)。右美托咪定组在手术开始后15、30、60 min时的Ramsay镇静评分分别为(2.9±0.6)、(3.3±0.5)、(3.0±0.6)分,均显著高于对照组的(2.1±0.3)、(2.1±0.2)、(1.9±0.3)分(P值均0.05)。右美托咪定组止血带引起疼痛的时间和止血带压迫耐受时间分别为(43.0±16.9)和(88.0±5.4)min,分别显著长于对照组的(29.0±8.7)和(76.0±10.8)min(P值均0.05)。右美托咪定组窦性心动过速、高血压发生率分别为2/20、1/20,分别显著低于对照组的12/20、13/20(P值均0.05)。结论臂丛神经阻滞麻醉下小剂量右美托咪定静脉给药可安全、有效地缓解止血带引起的疼痛。
[Abstract]:Objective to evaluate the preventive effect of low dose dexmetomidine on tourniquet pain under brachial plexus block anesthesia. Methods A total of 40 patients with upper limb operation were divided into right metoimidine group and control group with 20 cases in each group. All patients were under brachial plexus block anesthesia guided by nerve stimulator. The right metoimidine group received 1% lidocaine 10mL (50 渭 g dexmetomidine) 0.375% ropivacaine 25 mL, and the control group 1% lidocaine 10mL (not including dexmetoimidine) after inflating the tourniquet and slowly intravenous injection of dexmetoimidine 50 渭 L after inflating the tourniquet, while in the control group, 1% lidocaine 10mL was injected into the brachial plexus. ) 0.375% ropivacaine 25 mL, tourniquet inflated with 0.9% sodium chloride solution intravenously. The inflatable pressure of tourniquet was 200~250mmHg (1mmHg=0.133kPa) and the compression time was 90 min. The visual analogue score (VAS) of pain was recorded at 30 minutes after inflatable compression of tourniquet (VAS score), and the Ramsay sedation score was recorded before anesthesia, before operation and at 1530min after operation. Tourniquet tolerance, adverse cardiovascular events and other adverse reactions were observed. Results the VAS scores of dexmetomidine group were (0.8 卤0.6), () 2.1 卤1.6), (3.1 卤1.7), significantly lower than those of control group (2.7 卤2.0), (4.2 卤2.0), (5.8 卤2.5). The Ramsay sedation score of dexmetomidine group was (2.9 卤0.6), () 3.3 卤0.5), (3.0 卤0.6) min, significantly higher than that of control group (2.1 卤0.3), (2.1 卤0.2), (1.9 卤0.3) (P < 0.05). The time of pain induced by tourniquet and the time of compression tolerance of tourniquet were (43.0 卤16.9) and (88.0 卤5.4) min, respectively, which were significantly longer than those in control group (29.0 卤8.7) and (76.0 卤10.8) min (P, respectively. The incidence of sinus tachycardia and hypertension in the dexmetomidine group was 2 / 20 / 1 / 20, respectively, which was significantly lower than that in the control group (12 / 20 / 13 / 20, P = 0.05). Conclusion intravenous administration of dexmetomidine under brachial plexus block anesthesia is safe and effective in relieving pain caused by tourniquet.
【作者单位】：安徽省马鞍山市市立医疗集团市人民医院麻醉科;
【分类号】：R614

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