右美托咪定复合羟考酮或芬太尼辅助颈丛阻滞的临床观察  

The clinical observation of dexmedetomidine combined with oxycodone or fentanyl during brachial plexus blockade in the thyroid surgery

作　　者：邴彦秋 高光洁 徐迎阳 尚宇 

机构地区：[1]解放军第四六三医院麻醉科,沈阳110042

出　　处：《中国医师杂志》2016年第3期410-413,417,共5页Journal of Chinese Physician

摘　　要：目的 探析小剂量右美托咪啶静脉持续输注复合羟考酮或芬太尼辅助颈丛阻滞的应用效果.方法 60例ASA Ⅰ-Ⅱ级行甲状腺次全切或全切的甲状腺瘤患者,均行单侧颈深丛和双侧颈浅丛阻滞,随机双盲抽签方法均分为三组：单纯颈丛阻滞组（A组）、右美托咪啶联合芬太尼组（B组）和右美托咪啶联合羟考酮组（C组）.记录手术开始前（T0）、切皮时（T1）、分离腺体时（T2）、腺体切除后（T3）、手术结束时（T4）的血压（Bp）、心率（HR）,同时测定血浆去甲肾上腺素（NE）、皮质醇（Cor）、血糖（Glu）的浓度,并进行镇痛、镇静评分,记录局麻药用量和不良反应发生率.结果 与A组同时点比较,B和C组患者MAP、HR较低（P＜0.05）,应激激素NE、Cor、Glu明显较低（P＜0.05）;B和C组患者在T0～4时点Ramsay镇静评分明显优于A组（P＜0.05）;B和C组利多卡因追加量明显少于A组（P＜0.01）;B、C组患者术中寒战发生率明显低于A组（P＜0.01）;A和C组患者术中呛咳反应发生率明显低于B组（P＜0.01）.结论 小剂量右美托咪啶复合羟考酮辅助颈丛阻滞行甲状腺手术既消除术前患者紧张焦虑情绪,又可有效抑制围术期应激反应,保持血流动力学稳定,实施术中唤醒降低并发症,是麻醉辅助用药的新选择.Objective To investigate the effect of small dose of dexmedetornidine on venous continuous infusion combined with oxycodone or fentanyl during brachial plexus blockade.Methods Sixty thyroid patients （ASA Ⅰ or Ⅱ） undergone brachial plexus anesthesia for cutting or cutting thyroid tumor patients were randomly and double-blindly into three groups （n =20 in each group）.Group A：single brachial plexus anesthesia;group B：dexmedetornidine combined with fentanyl;group C：dexmedetornidine combined with oxycodone.Blood pressure （Bp）,heart rate （HR）,the determination of plasma norepinephrine （NE）,cortisol （Cor）,the concentration of blood glucose （Glu）,VAS,Ramsay calm score,local anesthetics dosage and side effect formation rate at the beginning operation （To）,skin incision （T1）,separation of the glands （T2）,gland excision （T3）,and the end of the surgery （T4） were recorded.Results Compared to group A,the mean arterial pressure （MAP）,HR,NE,Cor,and Glu were much lower at each time point （P 〈 0.05） in groups B and C;Ramsay calm score and VAS score were significantly better at each time point （P 〈 0.05）;the incidence of chills and lidocaine additional quantity were significantly lower （P 〈0.01）.However,compared to groups A and C,choking cough response rates were much higher in group B （P 〈 0.01）.Conclusions Small dose of dexmedetornidine on venous continuous infusion combined with oxycodone during brachial plexus blockade for thyroid patients both can eliminate the preoperative patients nervous anxiety,and effectively restrain perioperative stress response,maintain hemodynamics stable,implementation of intraoperative awaken to reduce complications.It is the new choice of anesthetic adjuvant.

关 键 词：右美托咪啶/投药和剂量 羟可酮/投药和剂量 芬太尼/投药和剂量 神经传导阻滞 颈丛 

分 类 号：R614[医药卫生—麻醉学]