不同剂量右美托咪定复合罗哌卡因臂丛阻滞用于小儿多指手术的效果比较  

Effects of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery

作　　者：杨世辉[1] 孙维国[1] 李永乐[1] 陈祥楠[1] 漆冬梅[1] 孙艺娟[1] 

机构地区：[1]广东省妇幼保健院麻醉科,广东广州510010

出　　处：《南方医科大学学报》2017年第6期833-836,共4页Journal of Southern Medical University

基　　金：广东省科技计划项目(2016ZC0183)

摘　　要：目的观察不同剂量右美托咪定(Dex)复合罗哌卡因腋路臂丛阻滞用于小儿多指手术的比较的效果及安全性。方法小儿多指手术患者80例,随机均分为:不同剂量Dex组(D1-3组)和对照组(C组)。D1-3组腋路臂丛用药分别为Dex 0.25、0.5、0.75μg/kg+0.25%罗哌卡因0.20 m L/kg,C组为0.25%罗哌卡因0.20 m L/kg。记录阻滞完成、起效、维持及术后苏醒时间及并发症情况。结果 D2组及D3组在起效时间及术后苏醒时间上均比C组短,而维持时间长,D3组比D1组在起效时间及术后苏醒时间上均缩短,而维持时间长。D1-3组的阻滞成功率高于C组,差异有统计学意义(P<0.05),D1-3组间无统计学差异。并发症方面,4组未出现血肿病例,各有1例患儿出现喉返神经阻滞,各有1例呼吸抑制,2或3例霍纳综合征,D3组出现1例患儿心率<70 min,经处理均安全恢复。结论单纯罗哌卡因或复合Dex臂丛神经阻滞,均可以用于小儿多指手术,中剂量Dex(0.5μg/kg)+0.25%罗哌卡因0.20 m L/kg的配伍较佳。Objective To observe the anesthetic effect and safety of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery. Methods Eighty children undergoing polydactyly surgery were randomized into 4 groups to receive brachial plexus nerve block with dexmedetomidine at 0.25, 0.50 or 0.75 μg/kg combined with 0.25%ropivacaine （0.20 mL/kg） （D1, D2, and D3 groups, respectively） or with 0.25%ropivacaine （0.20 mL/kg） only （control group）. The onset time, duration of brachial plexus nerve block, awakening time, success rate, and incidence of complications were compared among the groups. Results In D2 and D3 groups, the onset time and awakening time were shorter and anesthesia lasted longer than those in the control group. The onset time and awakening time were shorter and anesthesia maintenance time was longer in D3 group than in D1 group. The success rates of brachial plexus nerve block were significantly higher in D1-3 groups than in the control group （P〈0.05）. Hematoma was found in one of the patients. In each of the 4 groups, laryngeal nerve block occurred in 1 child and respiratory depression in another;2 or 3 patients had Horner syndrome, and 1 patient in D3 group experienced an episode of lowered heart beat to below 70 min-1. All the complications were managed properly and the patients all recovered uneventfully. Conclusion Brachial plexus nerve block with 0.5 μg/kg dexmedetomidine combined with 0.25% ropivacaine （0.20 mL/kg） is safe for effective anesthesia in children undergoing surgery for polydactyly.

关 键 词：小儿 多指手术 右美托咪定 罗哌卡因 神经阻滞 臂丛 

分 类 号：R726.1[医药卫生—儿科]