右美托咪定辅助下肢神经阻滞在骨科手术中的应用  

Application of dexmedetomidine combined with lower extremity nerve block in orthopaedic surgery

作　　者：张清福[1] 曹俊[1] 江伟[1] 葛东明[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《上海医学》2014年第1期42-44,共3页Shanghai Medical Journal

摘　　要：目的观察右美托咪定辅助下肢神经阻滞在骨科手术中应用的安全性和有效性。方法选取拟行下肢膝关节和膝关节以下手术的患者40例,随机分入试验组和对照组,每组20例。两组患者均在B超引导下实施股神经和坐骨神经阻滞,然后试验组患者经静脉微量输液泵注射右美托咪定,负荷剂量为1μg/kg(稀释至20mL,注射时间为20min),术中给予右美托咪定维持量0.2μg·kg-1·h-1。对照组患者经微量输液泵注射0.9%氯化钠溶液20mL(注射时间为20min)。所有患者均使用自动气压止血带,压力设置为70kPa,如果出现止血带不耐受则静脉注射芬太尼100μg。在神经阻滞前(T0)、神经阻滞后(T1)、手术开始时(即给予负荷剂量后,T2)、手术开始后15min(T3)、手术开始后30min(T4)、手术开始后45min(T5)各时间点,记录患者的平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、心率(HR)、呼吸频率(RR),并进行Ramsay镇静评分。记录止血带耐受时间和出血量。结果两组间在T0和T1时间点的MAP、HR、RR和SpO2的差异均无统计学意义(P值均>0.05);试验组在T2至T5时间点的HR和RR均显著低于对照组同时间点(P值均<0.05),SpO2的差异无统计学意义(P值均>0.05);试验组在T4和T5时间点的MAP均显著低于对照组同时间点(P值均<0.05)。试验组在T2、T3、T5时间点的HR和T2至T5时间点的RR均显著低于同组T0时间点(P值均<0.05)。对照组在T2至T5时间点的MAP显著高于同组T0时间点(P值均<0.05)。试验组在T2至T5时间点的Ramsay镇静评分均显著高于同组T0时间点和对照组同时间点(P值均<0.05)。试验组中仅3例患者加用芬太尼,对照组中11例患者加用芬太尼。试验组的止血带耐受时间显著长于对照组(P<0.05)。两组间手术时间和出血量的差异均无统计学意义(P值均>0.05)。结论右美托咪定可为神经阻滞下进行下肢手术的患者提供良好的镇静,减少芬太尼的使用,延长止血带耐受时间Objective To investigate the safety and efficacy of dexmedetomidine （DEX） combined with nerve block of lower extremity in orthopaedic surgery. Methods Forty patients scheduled for operation on or below knee joint were randomly divided into test group and control group. There were 20 cases in each group. All the patients received femoral nerve and sciatic nerve block under ultrasonic guidance. The patients in the test group received a loading dose of DEX 1 μg/kg （diluted to 20 mL, micro pump injection for 20 minutes） and maintenance dose of DEX 0.2 μg·kg-1· h-1. The patients in the control group received micro pump injection of 20 mL sodium chloride solution. Medical tourniquet with pressure of 70 kPa was used to reduce bleeding. A dose of fentanyl 100 μg was added to those who could not tolerate the tourniquet pain. Mean arterial pressure （MAP）, saturation of blood oxygen （SpO2）, heart rate （HR）, respiratory rate （RR） and Ramsay scores were recorded before （To） and after （T1） anesthesia, at the beginning of surgery （T2）, 15 min （T3）, 30 min （T4）, and 45 min （Ts） during the surgery. The tourniquet endurance time and blood loss were also recorded. Results There were no significant differences in MAP, HR or RR at To and T1 and SpO2 from To to Ts between two groups （all P〉0.05）. HR and RR from 1-2 to T2 and MAP at T4 and T5 in the test group were significantly lower than those in the control group （all P〈O. 05）. As compared with those at To, HR at T2, T3 and T5 and RR at T2 to T5 were significantly decreased in the test group, while MAP from T2 to T5 were significantly increased in the control group （allP〈0.05）. The Ramsay scores from T2 to T5 in the test group were significantly higher than those in the control group and that at To in the test group （all P〈0.05）. Fentanyl was applied in 3 cases in the test group and 11 cases in the control group. The tourniquet tolerance time in test group was significantly longer than that in the control g

关 键 词：右美托咪定 B超 下肢神经阻滞 骨科手术 

分 类 号：R614[医药卫生—麻醉学]