右美托咪定对臂丛麻醉行断指再植术患者应激反应的影响  

Effect of Dexmedetomidine on stress response in patients undergoing finger replantation with brachial plexus block

作　　者：伦明辉[1] 王雷[1] 赵宏[1] 

机构地区：[1]沈阳医学院附属中心医院麻醉科,辽宁沈阳110024

出　　处：《中国美容整形外科杂志》2015年第9期558-560,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 观察右美托咪定对腋路臂丛神经阻滞行断指再植患者应激反应的影响.方法 选择急诊断指再植术患者60例,ASA Ⅰ-Ⅱ级,腋鞘内注入0.375％罗哌卡因40ml,效果确切后,随机分为两组（n=30）：对照组（C组）和右美托咪定组（D组）.分别给予咪唑安定0.03 mg/kg和右美托咪定0.8 μg/kg负荷量,0.4μ,g/（kg·h）维持量至术毕前10 min.记录入室（T0）、臂丛神经阻滞后20m in（T1）、手术开始后1 h（T2）、术毕（T3）和术后24 h（T4）平均动脉压（MAP）、心率（HR）和血糖,并测血浆皮质醇（Cor）和去甲肾上腺素（NE）浓度.结果 两组血流动力学指标均稳定,D组在T2、T3时点,MAP和HR较TO时点下降（P＜0.05）,且低于C组（P＜0.05）;在T2、T3和T4时点两组患者Cor和NE水平与TO相比降低（P＜0.05）,且D组低于C组（P＜0.05）;两组血糖无明显差别（P＞0.05）.结论 腋路臂丛神经阻滞复合右美托咪定,能够抑制断指再植患者的应激反应.Objective To observe effect of dexmedetomidine （Dex） on stress in patients undergoing finger replantation with brachial plexus block. Methods Sixty ASA grade I -II patients undergoing emergency finger replantation were randomly divided into two groups （ n= 30） ： the control group （ group C） and the Dex group （ group D）, patients received axillary brachial plexus block with 40 ml of 0.375% Ropivacaine, 0.03 mg/kg mid- azolam was given in group C ; while Dex of 0.8 μg/kg load dose and 0.4 μg/（ kg· h） maintenance dose until 10 min before the end of surgery was administered in group D. MAP, HR, blood glucose, Cor and NE were measured at the time before anesthesia （T0）, 20 min after hrachial plexus block （ T1 ）, 1 h after beginning of operation （T2）, surgery completion （33） and 24 h after operation （T4）. Results Hemodynamic parameters in two groups were stable. Compared with TO, MAP and HR at T2, T3 in group D were decreased （ P〈 0.05）, and decreased compared with group C （ P〈 0.05 ）. Compared with TO, plasma concentrations of Cor and NE at T2, 33 and T4 in two groups were decreased （ P〈 0. 05 ）, and plasma stress hormones were decreased in group D compared with group C （ P〈 0. 05）. Blood glucose in two groups were no significant difference （ P〉 0.05 ）. Conclusion Axillary brachial plexus block combined with Dex can effectively restrain stress response in patients undergoing finger replantation.

关 键 词：右美托咪定 断指再植 臂丛神经阻滞 应激反应 

分 类 号：R614[医药卫生—麻醉学] R658.1[医药卫生—外科学]