右美托咪定混合罗哌卡因局部用药对全膝关节置换术患者止血带相关高血压的防治效果  

Effect of dexmedetomidine added to ropivacaine administered locally on prevention of tourniquet-related hypertension in patients undergoing total knee arthroplast

作　　者：何非[1] 鲍永娟[2] 吴丽[1] 张洁[1] 吴绪才[1] 董补怀[1] 

机构地区：[1]西安交通大学医学院附属红会医院麻醉科,710054 [2]河北省医学情报研究所《中华麻醉学杂志》编辑部

出　　处：《中华麻醉学杂志》2015年第12期1431-1434,共4页Chinese Journal of Anesthesiology

摘　　要：目的探讨右美托咪定混合罗哌卡因局部用药对全膝关节置换术患者止血带相关高血压的防治效果。方法单侧全膝关节置换术患者90例，ASA分级Ⅰ-Ⅲ级，年龄58～74岁，性别不限，体重60-78kg，采用随机数字表法，将其分为3组（n=30）：罗哌卡因组（R组）、右美托咪定混合罗哌卡因局部用药组（D＋R组）和右美托咪定静脉用药＋罗哌卡因组（Div＋R）组。股神经阻滞：R组注射0．5％罗哌卡因15ml；D＋R组注射混合液15ml：0．5％罗哌卡因20ml＋右美托咪定60μg；Div＋R组注射0．5％罗哌卡因15ml。股外侧皮神经阻滞：R组注射0．5％罗哌卡因5ml；D＋R组注射混合液5ml；Div＋R组注射0．5％罗哌卡因5ml。神经阻滞结束后全麻诱导，Div＋R组麻醉诱导前静脉输注右美托咪定0．5μg／kg，经10min输注完毕，随后以0．4μg·kg-1·h-1的速率维持至手术结束前30min。止血带充气压力266～304mmHg，时间设定90min。于麻醉诱导前（T0）、止血带充气即刻（T1）、充气后15、30、45、60、75、90min（T2-7）时记录MAP和HR。记录止血带充气期间高血压、低血压、心动过速和心动过缓的发生情况。拔除气管导管后行躁动评分。记录呼吸恢复时间、苏醒时间及气管拔管时间。结果与R组比较，D＋R组与Div＋R组T1-7时MAP和HR降低，高血压和心动过速发生率降低，心动过缓发生率升高，躁动评分降低（P〈0．05或0．01）；D＋R组与Div＋R组上述指标比较差异无统计学意义（P〉0．05）。3组呼吸恢复时间、苏醒时间及气管拔管时间比较差异无统计学意义（P〉0．05）。结论右美托咪定混合罗哌卡因局部用药可对全膝关节置换术患者止血带相关高血压产生防治效果，该效果与右美托咪定静脉用药无明显差异。Objective To investigate the effect of dexmedetomidine added to ropivacaine administered locally on prevention of tourniquet-related hypertension in the patients undergoing total knee arthroplast. Methods Ninety patients of both sexes, aged 58-74 yr, weighing 60-78 kg, of American Society of Anesthesiologists physical status Ⅰ -Ⅲ, scheduled for elective unilateral total knee arthroplast, were randomly divided into 3 groups （n = 30 each） using a random number table： ropivacaine group （groupR） , dexmedetomidine added to ropivacaine administered locally group （ group D ＋ R ） , and dexmedetomidine administered intravenously ＋ ropivacaine group （group Div＋R）. Femoral nerve block： 0.5% ropivacaine 15 ml was injected in group R; the mixture （ 15 ml） of 0.5% ropivacaine 20 ml plus dexmedetomidine 60 ixg was injected in group D＋R; 0.5% ropivacaine 15 ml was injected in group Div＋R. Lateral femoral cutaneous nerve block： 0.5% ropivacaine 5 ml was injected in group R; the mixture 5 ml was injected in group D＋R; 0.5% ropivacaine 5 ml was injected in group Div＋R. General anesthesia was induced after the end of nerve block. In group Div ＋ R, dexmedetomidine was infused as a bolus of 0.5 μg/kg over 10 min starting from anesthesia induction, followed by an infusion of 0.4 μg · kg-1 · h-1 until 30 min before the end of surgery. A tourniquet was applied and inflated （266-304 mmHg） within 90 min. Before induction of anesthesia （TO ）, and at 0, 15, 30, 45, 60, 75 and 90 min after the tourniquet was inflated （T1-7） , mean arterial pressure and heart rate were recorded. The occurrence of hypertension, hypotension, tachycardia and bradycardia was recorded when the tourniquet was inflated. Agitation was assessed and scored after removal of the endotracheal tube. The time for recovery of breathing, emergence time, and time for removal of the endotracheal tube were recorded. Results Compared with group R, the mean arterial pressure and heart rate were significantly decreased at

关 键 词：右美托咪啶 酰胺类 止血带 高血压 

分 类 号：R614[医药卫生—麻醉学]