右美托咪定联合罗哌卡因用于超声引导下肌间沟臂丛神经阻滞的麻醉效果观察
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摘要
目的观察右美托咪定联合罗哌卡因用于超声引导下肌间沟臂丛神经阻滞的麻醉效果。方法选取2017年4月至2018年6月在复旦大学附属华山医院北院接受上肢手术治疗的124例患者作为研究对象,以随机数表法将患者分为观察组和对照组,每组62例,两组患者均使用罗哌卡因配合超声波引导下肌间沟臂丛神经阻滞麻醉,观察组患者麻醉加用右美托咪定,而对照组患者加用等剂量医用生理盐水。比较两组患者麻醉阻滞起效时间、麻醉阻滞持续时间,患者麻醉前10 min (T1)、接受麻醉后20 min (T2)和40 min (T3)、手术完成后10 min (T4)的心率和平均动脉压,并对患者的麻醉效果进行评价。结果观察组患者的麻醉阻滞时间为(684.42±28.53) min,明显长于对照组的(583.32±25.53) min,麻醉阻滞起效时间为(11.23±0.97) min,明显短于对照组的(15.26±1.11) min,差异均具有统计学意义(P<0.05);T1时,观察组患者心率和平均动脉压分别为(80.85±4.99)次/min和(87.47±5.74) mmHg,分别与对照组的(80.91±5.28)次/min、(87.02±6.11) mmHg比较差异均无统计学意义(P>0.05);在T2、T3及T4时,观察组患者的心率分别为(76.11±5.26)次/min、(75.23±6.17)次/min、(78.74±5.21)次/min,均高于对照组的(66.29±5.41)次/min、(65.78±6.03)次/min、(72.78±5.26)次/min,平均动脉压分别为(80.55±6.11) mmHg、(79.38±6.04) mmHg、(83.96±6.02) mm Hg,均低于对照组的(85.38±7.08) mmHg、(84.27±6.42) mmHg、(86.24±6.37) mmHg,差异均具有统计学意义(P<0.05);观察组患者麻醉效果优良率为93.55%,明显高于对照组的73.42%,差异具有统计学意义(P<0.05)。结论右美托咪定联合罗哌卡因在超声引导下对肌间沟臂丛神经进行麻醉阻滞效果显著,可为手术顺利进行提供有效保障,值得临床借鉴使用。
Objective To observe the anesthetic effects of dexmedetomidine combined with ropivacaine for ultrasound-guided interscalene brachial plexus block. Methods A total of 124 patients who underwent upper extremity surgery in the North Campus, Huashan Hospital Affiliated to Fudan University from April 2017 to June 2018 were selected in the study. They were divided into observation group and control group by random number table method, with 62 cases in each group. Two groups of patients were all treated with ropivacaine for ultrasound-guided interscalene brachial plexus block. Patients in the observation group were additionally given dexmedetomidine for anesthesia, while patients in the control group were additionally given an equal dose of medical saline. The onset time of anesthesia block, duration of anesthesia block, heart rate, and mean arteries pressure at 10 min before anesthesia(T1), 20 min and 40 min after anesthesia(T2 and T3), 10 min after completion of surgery(T4), and anesthesia effect of the two groups were compared,and the effect of anesthesia was evaluated. Results The anesthesia block time of the observation group was(684.42±28.53) min, which was significantly longer than(583.32±25.53) min of the control group, while the onset time of anesthesia block of the observation group was(11.23±0.97) min, which was significantly shorter than(15.26±1.11) min of the control group(P<0.05). At T1, the heart rate and mean arterial pressure of the observation group were(80.85 ±4.99) beats/min and(87.47±5.74) mm Hg, respectively, which was not significantly different from(80.91±5.28) beats/min,(87.02 ± 6.11) mmHg of the control group(P>0.05). At T2, T3 and T4, the heart rates of the observation group were(76.11±5.26) beats/min,(75.23±6.17) beats/min,(78.74±5.21) beats/min, which were significantly higher than(66.29±5.41) beats/min,(65.78±6.03) beats/min,(72.78±5.26) beats/min of the control group(P<0.05). The mean arterial pressures of the observation group were(80.55±6.11) mmHg,(79.38±6.04) mmHg,(83.96±6.02) mmHg at T2, T3 and T4,which were lower than(85.38±7.08) mmHg,(84.27±6.42) mmHg,(86.24±6.37) mmHg of the control group(P<0.05).The excellent rate of anesthesia effect was 93.55% in the observation group, which was significantly higher than 73.42%in the control group(P<0.05). Conclusion Dexmedetomidine combined with ropivacaine has significant effect for ultrasound-guided interscalene brachial plexus block, which can provide an effective guarantee for the smooth operation and is worthy of clinical reference.
Objective To observe the anesthetic effects of dexmedetomidine combined with ropivacaine for ultrasound-guided interscalene brachial plexus block. Methods A total of 124 patients who underwent upper extremity surgery in the North Campus, Huashan Hospital Affiliated to Fudan University from April 2017 to June 2018 were selected in the study. They were divided into observation group and control group by random number table method, with 62 cases in each group. Two groups of patients were all treated with ropivacaine for ultrasound-guided interscalene brachial plexus block. Patients in the observation group were additionally given dexmedetomidine for anesthesia, while patients in the control group were additionally given an equal dose of medical saline. The onset time of anesthesia block, duration of anesthesia block, heart rate, and mean arteries pressure at 10 min before anesthesia(T1), 20 min and 40 min after anesthesia(T2 and T3), 10 min after completion of surgery(T4), and anesthesia effect of the two groups were compared,and the effect of anesthesia was evaluated. Results The anesthesia block time of the observation group was(684.42±28.53) min, which was significantly longer than(583.32±25.53) min of the control group, while the onset time of anesthesia block of the observation group was(11.23±0.97) min, which was significantly shorter than(15.26±1.11) min of the control group(P<0.05). At T1, the heart rate and mean arterial pressure of the observation group were(80.85 ±4.99) beats/min and(87.47±5.74) mm Hg, respectively, which was not significantly different from(80.91±5.28) beats/min,(87.02 ± 6.11) mmHg of the control group(P>0.05). At T2, T3 and T4, the heart rates of the observation group were(76.11±5.26) beats/min,(75.23±6.17) beats/min,(78.74±5.21) beats/min, which were significantly higher than(66.29±5.41) beats/min,(65.78±6.03) beats/min,(72.78±5.26) beats/min of the control group(P<0.05). The mean arterial pressures of the observation group were(80.55±6.11) mmHg,(79.38±6.04) mmHg,(83.96±6.02) mmHg at T2, T3 and T4,which were lower than(85.38±7.08) mmHg,(84.27±6.42) mmHg,(86.24±6.37) mmHg of the control group(P<0.05).The excellent rate of anesthesia effect was 93.55% in the observation group, which was significantly higher than 73.42%in the control group(P<0.05). Conclusion Dexmedetomidine combined with ropivacaine has significant effect for ultrasound-guided interscalene brachial plexus block, which can provide an effective guarantee for the smooth operation and is worthy of clinical reference.
引文
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[2]王丽萍,任莉,曾路路,等.罗哌卡因局部浸润联合右美托咪定预防性镇痛对膝关节镜手术后镇痛的影响[J].中国当代医药,2018,25(21):76-78.
[3]朱俊峰,冯兆明.右美托咪定对超声引导下罗哌卡因臂丛神经阻滞效果的影响[J].中华生物医学工程杂志,2013,19(5):390-393.
[4]郑波,包倩倩,何海娟,等.右美托咪定注射液联合罗哌卡因注射液用于臂丛神经阻滞的临床研究[J].中国临床药理学杂志,2018,34(11):1321-1323.
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[6]邹鲁,张仁斌,商建飞,等.超声引导锁骨上臂丛神经阻滞麻醉效果观察[J].山东医药,2015,55(5):62-64.
[7]孟永生,钱涛,孙灿林.右美托咪定联合罗哌卡因对臂丛神经阻滞效果的影响[J].现代医学与健康研究电子杂志,2018,2(8):1-2.
[8]YONG L,GUANG B.Intraperitoneal ropivacaine instillation versus no intraperitoneal ropivacaine instillation for laparoscopic cholecystectomy:a systematic review and meta-analysis[J].Int J Surg,2017,44:229-243.
[9]胡群,李建华.右美托咪定联合罗哌卡因在腋路臂丛神经阻滞中的应用效果[J].医学理论与实践,2018,31(3):388-390.
[10]汪辉,陈金保,王萍.超声引导右美托咪定复合罗哌卡因TPVB对开胸手术麻醉及术后镇痛的影响[J].解放军预防医学杂志,2018,36(5):676-679.
[11]余露,盛良,杭东元,等.不同剂量右美托咪定对罗哌卡因肋间神经阻滞效果的影响[J].临床麻醉学杂志,2016,32(12):1217-1218.
[12]杨旭刚,冯昌盛.右美托咪定联合罗哌卡因连续股神经阻滞用于全膝关节置换术的镇痛效果分析[J].重庆医学,2018,47(22):2978-2980.
[2]王丽萍,任莉,曾路路,等.罗哌卡因局部浸润联合右美托咪定预防性镇痛对膝关节镜手术后镇痛的影响[J].中国当代医药,2018,25(21):76-78.
[3]朱俊峰,冯兆明.右美托咪定对超声引导下罗哌卡因臂丛神经阻滞效果的影响[J].中华生物医学工程杂志,2013,19(5):390-393.
[4]郑波,包倩倩,何海娟,等.右美托咪定注射液联合罗哌卡因注射液用于臂丛神经阻滞的临床研究[J].中国临床药理学杂志,2018,34(11):1321-1323.
[5]DILLON RC,PALMA JA,SPALINK CL,et al.Dexmedetomidine for refractory adrenergic crisis in familial dysautonomia[J].Clin Auton Res,2017,27(1):1-9.
[6]邹鲁,张仁斌,商建飞,等.超声引导锁骨上臂丛神经阻滞麻醉效果观察[J].山东医药,2015,55(5):62-64.
[7]孟永生,钱涛,孙灿林.右美托咪定联合罗哌卡因对臂丛神经阻滞效果的影响[J].现代医学与健康研究电子杂志,2018,2(8):1-2.
[8]YONG L,GUANG B.Intraperitoneal ropivacaine instillation versus no intraperitoneal ropivacaine instillation for laparoscopic cholecystectomy:a systematic review and meta-analysis[J].Int J Surg,2017,44:229-243.
[9]胡群,李建华.右美托咪定联合罗哌卡因在腋路臂丛神经阻滞中的应用效果[J].医学理论与实践,2018,31(3):388-390.
[10]汪辉,陈金保,王萍.超声引导右美托咪定复合罗哌卡因TPVB对开胸手术麻醉及术后镇痛的影响[J].解放军预防医学杂志,2018,36(5):676-679.
[11]余露,盛良,杭东元,等.不同剂量右美托咪定对罗哌卡因肋间神经阻滞效果的影响[J].临床麻醉学杂志,2016,32(12):1217-1218.
[12]杨旭刚,冯昌盛.右美托咪定联合罗哌卡因连续股神经阻滞用于全膝关节置换术的镇痛效果分析[J].重庆医学,2018,47(22):2978-2980.