右美托咪定在外周神经阻滞中使用对止血带反应的影响  

Effect of Peripheral Nerve Block with Dexmedetomidine on Tourniquet-related Responses

作　　者：徐卫财 王文元[1] 陈龙[1] 胡双飞[1] 

机构地区：[1]浙江省人民医院麻醉科,浙江省杭州市310014

出　　处：《中国全科医学》2017年第32期4008-4012,共5页Chinese General Practice

摘　　要：目的探讨右美托咪定复合局部麻醉药在外周神经阻滞中使用对止血带引起的血流动力学及氧化应激损伤的影响。方法选取2015年5月—2016年2月浙江省人民医院行上肢手术,需使用止血带及臂丛麻醉且止血带使用时间>45 min的患者122例,采用随机数字表法将患者分为对照组(C组,n=39)、右美托咪定静脉组(Ⅳ组,n=40)和右美托咪定外周神经阻滞组(P组,n=43)。入室后行B超下肌间沟臂丛麻醉,C组不使用右美托咪定,Ⅳ组静脉中使用右美托咪定,P组外周神经阻滞中使用右美托咪定复合局部麻醉药。观察并记录入室(T01)、上止血带前即刻(T02)、上止血带后30 min(T11)、上止血带后45 min(T12)、松止血带后即刻(T21)、松止血带后5 min(T22)、松止血带后10 min(T23)的平均动脉压和心率,并观察和记录上止血带期间(T13)最高平均动脉压和最慢心率。采用酶联免疫吸附试验(ELISA)法检测T01、T21、T22、T23时血清丙二醛(MDA)、超氧化物歧化酶(SOD)水平。结果 T02、T11、T12、T13时,Ⅳ组平均动脉压低于C组、P组平均动脉压低于C组、高于Ⅳ组;T21时,Ⅳ组平均动脉压高于C组,P组平均动脉压高于C组、低于Ⅳ组(P<0.05)。T01、T02、T11、T12、T13、T21、T22、T23时,Ⅳ组心率低于C组(P<0.05);T02、T11、T12、T13、T21、T22、T23时,P组心率低于C组、高于Ⅳ组(P<0.05)。T22、T23时,C组、Ⅳ组和P组MDA水平高于T01,C组和P组SOD水平低于T01(P<0.05);T23时,Ⅳ组SOD水平低于T01(P<0.05)。T22、T23时,Ⅳ组MDA水平低于C组,P组MDA水平低于C组、高于Ⅳ组;Ⅳ组SOD水平高于C组,P组SOD水平高于C组、低于Ⅳ组(P<0.05)。结论右美托咪定加入局部麻醉药中进行外周神经阻滞可以减轻止血带反应,降低氧化应激损伤,但效果不如静脉中使用。Objective To investigate the impact of dexmedetomidine combined with local anesthetics used in peripheral nerve block on the tourniquet-induced hemodynamic and oxidative stress injury. Methods We enrolled 122 patients who underwent upper limb surgery in Zhejiang Provincial People＇ s Hospital from May 2015 to February 2016 with interscalene brachial plexus block and tourniquet inflation pressure more than 45 min and randomized them to the control group（ group C,n= 39） receiving B ultrasound-guided interscalene brachial plexus block without dexmedetomidine, intravenous infusion of dexmedetomidine（ group Ⅳ,n = 40） receiving B ultrasound-guided interscalene brachial plexus block with intravenous infusion of dexmedetomidine,and peripheral nerve block with dexmedetomidine group（ group P, n = 43） receiving B ultrasound-guided interscalene brachial plexus block with dexmedetomidine combined with local anesthetics. The changes of mean arterial pressure（ MAP） and mean heart rate（ HR） in each group were recorded at basic state（ T01）,before the tourniauet inflated（ T02）,30 min after the tourniauet inflated（ T11）,45 min after the tourniauet inflated（ T12）,immediately after the release of the tourniquet（ T21）,5 min after the release of the tourniquet（ T22）,10 min after the release of the tourniquet（ T23）. The maximum MAP and minimum HR during the period of tourniauet inflation（ T13） were observed and recorded. ELISA was used to detect the levels of malondialdehvde（ MDA） and superoxide dismutase（ SOD） in serum at T01,T21,T22 and T23. Results At T02,T11,T12 and T13,group Ⅳ had lower MAP than group C,group P had lower MAP than group C but higher MAP than group Ⅳ; at T21,group Ⅳ had higher MAP than group C,group P had higher MAP than group C but lower MAP than group Ⅳ（ P〈0. 05）. At T01,T02,T11,T12,T13,T21,T22 and T23,group Ⅳ showed lower mean HR than group C（ P〈0. 05）. At T02,T11,T12,T13,T21,T22 and T23,group P demonstrated less mean HR than grou

关 键 词：抗交感神经药 右美托咪定 臂丛 止血带 

分 类 号：R971.94[医药卫生—药品]