右美托咪定预防超声引导臂丛神经阻滞止血带疼痛效果观察  

Effect of dexmedetomidine on prevention of tourniquet pain in ultrasound-guided brachial plexus blockade

作　　者：张晓侠[1] 聂明辉[2] 王志学[1] 刘新伟[1] 董龙[1] 李汝泓[1] 于铁莉[1] ZHANG Xiaoxia;NIE Minghui;WANG Zhixue;LIU Xinwei;DONG Long;LI Ruhong;YU Tieli(Department of Anesthesiology,Affiliated Hospital of Chengde Medical university;Department of Ultrasonography, Affiliated Hospital of Chengde Medical university,Chengde 067000 China)

机构地区：[1]承德医学院附属医院麻醉科,河北承德067000 [2]承德医学院附属医院超声科,河北承德067000

出　　处：《现代仪器与医疗》2017年第1期35-37,共3页Modern Instruments & Medical Treatment

基　　金：承德市科学技术研究与发展计划项目;编号201601A038

摘　　要：目的 :观察右美托咪定预防超声引导臂丛神经阻滞止血带疼痛的临床效果。方法 :选择2014年6月至2016年6月于我院在臂丛神经阻滞下行手术治疗的断指、断腕或断臂患者101例,随机分为右美托咪定组(A组,n=50例),罗哌卡因组(B组,n=51例)。止血带充气前0.5h,A组患者先静脉泵注右美托咪定1.0ug/kg,10min后以0.5ug/kg.h的速度恒速泵注至手术结束前15min,B组患者同时间内泵注等体积的生理盐水。记录两组止血带充气前(T1)、止血带充气30min时(T2)、止血带充气60min时(T3)、90min时(T4)及止血带放气10min后(T5)患者生命体征(MAP、HR)变化,并分别于T1~T5时间点采用VAS评分法和Ramsay镇静评分评估患者镇痛、镇静评分,记录患者术中出现的不良反应。结果 :两组患者T1和T5时间点MAP和HR相比差异无统计学意义,T2~T4时间点A组患者MAP和HR明显低于B组患者,差异有统计学意义,P<0.05;两组患者T1时间点VAS评分和Ramsay评分相比差异无统计学意义,P>0.05,T2~T5时间点A组患者VAS评分明显低于B组且A组患者的Ramsay评分明显高于B组,差异有统计学意义,P<0.05;B组发生的躁动的患者例数明显高于A组患者,差异有统计学意义,两组患者发生心动过缓、低血压、呼吸抑制的例数相比差异无统计学意义。结论 :右美托咪定可安全用于臂丛神经阻滞的手术患者,不仅可以有效减少患者止血带疼痛发生率,而且能减少患者术中烦躁的发生。Objective: This study objective was to observe the clinical effect of dexmedetomidine on the prevention of tourniquet pain in ultrasound-guided brachial plexus blockade. Methods: 101 patients scheduled for surgery of upper extremities under brachial plexus blockade guided by ultrasonography from June 2014 to June 2016 in our hospital were randomly divided into two groups: dexmedetomidine group (group A, n=50) and ropivacaine group (group B, n=51).0.5 h before the tourniquet was inflated, the patients in group A were injected with 1.0 μg/kg dexmedetomidine for 10 mins, and then pumped at a constant speed of 0.5 μg/ kg?h until 15 mins before the end of the operation. Group B was pumped into the same volume of saline at the same time. The changes of vital signs (MAP, HR) in the patients before tourniquet inflation (T1), at 30 mins (T2), 60 mins (T3), 90 mins (T4) and 10 mins after tourniquet inflation (T5), and the analgesic and sedation scores were evaluated by Visual Analogue Scale (VAS) and Ramsay Sedation Scale (RSS) at T1-T5 respectively, and the adverse effects were recorded. Results: There was no significant difference in MAP and HR between the two groups at T1 and T5. The MAP and HR of group A were significantly lower than those of group B from the time points of T2 to T4 (P<0.05); There was no significant difference in the scores of VAS and RSS between the two groups at the time point of T1, and the VAS scores of group A were significantly lower than those of group B from the time points of T2 to T5, and the Ramsay score of group A were significantly higher than those of group B from the time points of T2 to T5 (P<0.05). The number of patients with agitation in group B was significantly higher than that in group A (P<0.05). There was no statistical significance between the two groups in the incidence of bradycardia, hypotension and respiratory depression. Conclusions: Dexmedetomidine can safely be used in patients with brachial plexus blockade,which can not only reduce the incidence of tourniquet pain, bu

关 键 词：右美托咪定 臂丛神经阻滞 止血带疼痛 上肢手术 

分 类 号：R614[医药卫生—麻醉学]