右美托咪定对颈丛阻滞患者术中镇痛、镇静以及心率变异性的影响  

Effects of dexmedetomidine on analgesia,sedation and heart rate variability in thyroid surgery patients receiving cervical plexus block

作　　者：韦克[1] 邓军[1] 黄仕英[1] 李明良[1] 左朝晖[1] 刘俊福[1] 赵兰花[2] WEI Ke;DENG Jun;HUANG Shi-ying;LI Ming-liang;ZUO Chao-hui;LIU Jun-fu;ZHAO Lan-hua(Department of Anesthesiology,Affiliated of Hospital for Youjiang Medical University for Nationalities,Guangxi Baise 533000,China;Department of Obstetrics,the Maternity ＆ Children＇s Healthcare Hospital of Baise,Guangxi Baise 533000,China)

机构地区：[1]右江民族医学院附属医院麻醉科,广西百色533000 [2]广西百色市妇幼保健院产科,广西百色533000

出　　处：《中国医院药学杂志》2018年第16期1730-1734,共5页Chinese Journal of Hospital Pharmacy

基　　金：广西卫计委资助项目(编号:Z2014608)

摘　　要：目的:观察右美托咪定对颈丛阻滞患者术中镇痛、镇静以及心率变异性(HRV)的影响。方法:66例患者随机分对照组和右美托咪定(DEX)组。DEX组:30μg右美托咪定(1 mL)复合0.375%左布比卡因(29 mL)超声引导双侧颈4颈丛浅支阻滞和单侧颈3、颈4颈丛深支阻滞;首负荷0.5μg·kg-1右美托咪定和维持剂量0.2μg·kg-1·h-1右美托咪定持续至术毕。对照组:生理盐水(1 mL)复合0.375%左布比卡因(29 mL)行颈丛阻滞,其方法同DEX组;等量生理盐水同速率首负荷和维持持续至术毕。比较两组各个时(T0~T3)Ramsay镇静评分、视觉模拟评分(VAS)、平均动脉压、心率以及心率变异频域参数。结果:DEX组T1~T3时Ramsay评分高于对照组,VAS评分低于对照组,有统计学意义(P<0.05)。DEX组T1~T3时低频功率low frequency power(LF)、高频功率(HF)、LF/HF、总功率(TP)与对照组比较,统计学意义(P<0.05)。结论:右美托咪定复合颈丛阻滞能提高术中镇痛,减少深度镇静,并能维持血流动力学和心率变异稳定,安全性较高。OBJECTIVE To observe the effects of dexmedetomidine on analgesia,sedation and heart rate variability（HRV）in the patients received cervical plexus block.METHODS Totally 66 patients undergone thyroidectomy were randomly divided into the control group and the dexmedetomidine group（the DEX group）.Patients in the DEX group undergone cervical plexus block with 30 mL of mixture composed of 30μg dexmedetomidine（1 mL）and 0.375%levobupivacaine（29 mL）.Bilateral superficial cervical plexus block in the DEX group patients was performed under ultrasound guide by the midpoint of the posterior border of the sternocleidomastoid muscle.Unilateral deep cervical plexus block in the DEX group patients was performed by the third cervical vertebra（C3）and the fourth cervical vertebra（C4）.Dexmedetomidine was intravenously injected at the initial load dose of 0.5μg·kg-1 and then intravenously infused at the maintaining dose of 0.2μg·kg-1·h-1 til the end of surgery in DEX group.Patients in the control group undergone cervical plexus block with 30 mL mixture composed of natural saline（1 mL）and 0.375%levobupivacaine（29 mL）by using the same method,received equal volume of normal saline at the same infusion rate.Ramsay sedation score,visual analogue scale scores（VAS）,heart rate（HR）,mean arterial pressure（MAP）and these frequency domain parameters of heart rate variability（HRV）at different time（from T0 to T3）were compared.These frequency domain parameters of HRV were including total power（TP）,low frequency power（LF）,high frequency power（HF）and LF/HF.RESULTS From T1 to T3,the Ramsay sedation score in the DEX group was higher than that in the control group（P〈0.05）,however VSA in the DEX group was lower than that in the control group（P〈0.05）.From T1 to T3,the low frequency power（LF）,high frequency power（HF）,LF/HF and total power（TP）in the control group were compared with the control group（P〈0.05）.CONCLUSION Dexmedetomidine combined with cervical plex

关 键 词：右美托咪定 颈丛阻滞 镇痛、镇静 血流动力学 心率变异性 

分 类 号：R969[医药卫生—药理学]