罗哌卡因复合右美托咪定对超声引导下腋路臂丛神经阻滞麻醉的影响

发布时间：2018-10-31 13:38

【摘要】：目的评价罗哌卡因复合右美托咪定应用于超声引导下腋路臂丛神经阻滞麻醉的有效性和安全性。方法择期行前臂或手部手术的患者120例被随机分入4组。在超声引导下行腋路臂丛神经(正中神经、尺神经、桡神经、肌皮神经)阻滞麻醉,罗哌卡因组和罗哌卡因+右美托咪定50静脉组患者4支神经各注射0.5%罗哌卡因7mL,罗哌卡因+右美托咪定50局部组患者4支神经各注射0.5%罗哌卡因和50μg右美托咪定混合液7mL,罗哌卡因+右美托咪定100局部组患者4支神经各注射0.5%罗哌卡因和100μg右美托咪定混合液7mL。罗哌卡因组、罗哌卡因+右美托咪定50局部组、罗哌卡因+右美托咪定100局部组患者在手术开始后静脉输注0.9%氯化钠溶液40mL/h,罗哌卡因+右美托咪定50静脉组患者在手术开始后静脉输注右美托咪定50μg(稀释至20mL,40 mL/h)。在麻醉前(T0)和麻醉后15 min(T1)、30 min(T2)、45 min(T3)、60min(T4)各时间点,记录患者的心率(HR)、平均动脉压(MAP)和镇静评分,以及4组患者的感觉和运动阻滞起效时间、运动阻滞时间、镇痛持续时间。结果罗哌卡因+右美托咪定50局部组和罗哌卡因+右美托咪定100局部组的感觉和运动阻滞起效时间均显著短于罗哌卡因组(P值均0.05),运动阻滞时间和镇痛持续时间均显著长于罗哌卡因组(P值均0.05);罗哌卡因+右美托咪定50静脉组与罗哌卡因组间差异均无统计学意义(P值均0.05)。罗哌卡因+右美托咪定100局部组在T2、T3、T4时间点的HR和MAP分别显著低于罗哌卡因+右美托咪定50局部组和罗哌卡因组同时间点(P值均0.05),罗哌卡因+右美托咪定50静脉组在T3和T4时间点的HR和MAP分别显著低于罗哌卡因+右美托咪定50局部组和罗哌卡因组同时间点(P值均0.05)。结论超声引导下行腋路臂丛神经阻滞时,罗哌卡因局部复合50μg右美托咪定可以缩短感觉和运动阻滞起效时间,并延长运动阻滞时间和镇痛持续时间,且对血压和HR的影响小。
[Abstract]:Objective to evaluate the efficacy and safety of ropivacaine combined with dexmetidine in axillary brachial plexus block anesthesia. Methods 120 patients undergoing forearm or hand surgery were randomly divided into 4 groups. The axillary brachial plexus nerve (median nerve, ulnar nerve, radial nerve, musculocutaneous nerve) was anesthetized under the guidance of ultrasound. The patients in ropivacaine group and ropivacaine dexmetomidine 50 vein group were injected with 0.5% ropivacaine 7 mL each. The patients in ropivacaine dexmetomidine 50 local group were given 0.5% ropivacaine and 50 渭 g dexmetomidine mixture (7 mL). The patients of ropivacaine dexmetomidine 100 local group were injected with 0.5% ropivacaine and 100 渭 g dexmetomidine mixture for 7 mL. Ropivacaine group, ropivacaine dexmetomidine 50 local group, ropivacaine dexmetomidine 100 local group were intravenously infused with 0.9% sodium chloride solution 40 mL / h after operation. Patients in the ropivacaine dexmetomidine 50 group received dexmetomidine 50 渭 g (diluted to 20 mL / L for 40 mL/h) after operation. Heart rate (HR), mean arterial pressure (MAP) and sedation score were recorded before and 15 min (T1), 30 min (T2), 45 min (T3), 60min (T4) before and after anesthesia. The onset time of sensory and motor block, the time of motor block and the duration of analgesia were also studied in the 4 groups. Results the onset time of sensory and motor block in ropivacaine dexmetomidine 50 group and ropivacaine dexmetomidine 100 group was significantly shorter than that in ropivacaine group (P < 0.05). The time of motor block and the duration of analgesia were significantly longer than those of ropivacaine group (P < 0.05). There was no significant difference between ropivacaine dexmetomidine 50 intravenous group and ropivacaine group (P 0.05). The HR and MAP of ropivacaine dexmetomidine 100 local group were significantly lower than those of ropivacaine dexmetomidine 50 local group and ropivacaine group at the same time point (P < 0. 05). The HR and MAP of ropivacaine dexmetomidine 50 intravenous group at T3 and T4 were significantly lower than that of ropivacaine dexmetomidine 50 local group and ropivacaine group at the same time point (P < 0. 05). Conclusion during axillary brachial plexus block guided by ultrasound, ropivacaine combined with 50 渭 g dexmetomidine can shorten the onset time of sensory and motor block, prolong the duration of motor block and analgesia, and have little effect on blood pressure and HR.
【作者单位】：上海交通大学医学院附属新华医院麻醉科;
【分类号】：R614

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