右美托咪定复合罗哌卡因头皮神经阻滞在颅骨修补术中的应用  

Application of dexmedetomidine combined with ropivacaine in scalp nerve block for cranioplasty

作　　者：王志刚 刘伟亮[2] 徐红阳 宋永波 彭天亮 Wang Zhigang;Liu Weiliang;Xu Hongyang(Department of Anesthesiology,Weifang Medical University,Weifang 261053)

机构地区：[1]潍坊医学院麻醉学系,山东潍坊261053 [2]潍坊市人民医院麻醉科 [3]东营市人民医院麻醉科 [4]潍坊市人民医院脑科医院麻醉科

出　　处：《中国现代医药杂志》2020年第3期28-31,共4页Modern Medicine Journal of China

摘　　要：目的观察右美托咪定复合罗哌卡因行头皮神经阻滞麻醉在对颅骨修补术中的临床效果.方法选择择期行颅骨修补术的患者60例,ASAⅠ或Ⅱ级,分为C组及D组.C组用1ml生理盐水、D组用1μg/kg的右美托咪定(Dex)稀释至1ml,分别加入0.5%罗哌卡因局部麻醉药中,在全身麻醉诱导前行头皮神经阻滞.记录感觉神经阻滞起效时间、作用时间、镇痛时间、首次疼痛VAS评分;记录患者麻醉诱导前(T0)、切皮即刻(T1)、分离皮瓣(T2)、固定钛网(T3)、缝皮时(T4)和拔管后5min(T5)的心率(HR)、平均动脉压(MAP)和血氧饱和度(SpO2)变化,记录不良反应发生情况.结果与C组比较,D组感觉神经阻滞起效时间缩短,作用时间及术后镇痛时间延长(P<0.05).与C组比较,T1~T5时D组MAP降低、HR减慢,差异有统计学意义(P<0.05).两组在T0时MAP、HP及各点时SpO2比较,差异无统计学意义(P>0.05).D组有3例患者出现心动过缓;两组患者均未出现恶心、呕吐、低氧血症及局麻药中毒等不良反应.结论右美托咪定复合罗哌卡因用于颅骨修补术可明显增强头皮神经阻滞麻醉效果,保持血流动力学的稳定、缩短感觉神经阻滞起效时间、延长感觉神经阻滞恢复时间,利于术后镇痛.Objective To observe the clinical effect of dexmedetomidine combined with ropivacaine in scalp nerve block anesthesia for cranioplasty.Methods 60 patients(ASAⅠorⅡ)who underwent selective cranioplasty were randomly divided into group C and group D.Group C accepted 1ml normal saline and group D was diluted to 1ml with 1μg/kg dexmedetomidine(Dex),and then added 0.5%ropivacaine local anesthetic,respectively,underwent scalp nerve block before induction of general anesthesia.The onset time,action time,analgesia time and VAS score of first pain of sensory nerve block were recorded.The changes of heart rate(HR),mean arterial pressure(MAP)and blood oxygen saturation(SpO2)were recorded before anesthesia induction(T0),immediately after skin incision(T1),flap separation(T2),titanium mesh fixation(T3),suture(T4)and 5 minutes after extubation(T5),and the incidence of adverse reactions was recorded.Results Compared with group C,the onset time of sensory nerve block in group D shortened,the effect time and postoperative analgesia time prolonged(P<0.05),MAP and HR decreased in group D from T1 to T5,with statistically significant differences(P<0.05).There was no significant difference in MAP,HR at T0 and SpO2 at each time point between the two groups(P>0.05).There were 3 cases of bradycardia in group D,and no adverse reactions such as nausea,vomiting,hypoxemia and local anesthetic poisoning occurred in the two groups.Conclusion Dexmedetomidine combined with ropivacaine can significantly enhance the anesthesia effect of scalp nerve block,maintain the stability of hemodynamics,shorten the onset time of sensory nerve block,and prolong the recovery time of sensory nerve block,which is conducive for postoperative analgesia.

关 键 词：颅骨修补术 头皮神经阻滞 右美托咪定 

分 类 号：R614[医药卫生—麻醉学]