右美托咪定局部用药对糖尿病足患者罗哌卡因坐骨神经阻滞半数有效浓度的影响  

Effect of Local Application of Dexmedetomidine on Median Effective Concentration of Ropivacaine for Sciatic Nerve Block in Diabetic Foot Patients

作　　者：柯瑜君 陈鹭[1] 林文谦 林献忠[1] KE Yujun;CHEN Lu;LIN Wenqian;LIN Xianzhong(Department of Anesthesiology,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院麻醉科,福州350005

出　　处：《福建医科大学学报》2020年第3期192-195,共4页Journal of Fujian Medical University

基　　金：福建省卫生厅青年科研课题(2016-2-17)。

摘　　要：目的探讨右美托咪定局部用药对糖尿病足患者罗哌卡因坐骨神经阻滞半数有效浓度(EC 50)的影响。方法收集择期行单侧下肢足踝部清创术的糖尿病足患者57例,随机分为两组:对照组(C组)与右美托咪定组(D组),均在超声引导下行隐神经联合腘窝坐骨神经阻滞。隐神经阻滞使用0.5%罗哌卡因10 mL,坐骨神经阻滞时C组仅使用罗哌卡因20 mL,D组使用不同浓度罗哌卡因与1μg/kg右美托咪定的混合液20 mL。采用序贯法设定罗哌卡因的浓度,初始浓度为0.5%,相邻浓度比值为1∶1.2,若注药后30 min内坐骨神经支配区域感觉阻滞完全,下一例则减少一级浓度,反之则增加一级浓度,有连续8个上下交叉停止试验。采用概率单位回归法计算两组罗哌卡因相应的EC 50及其95%可信区间。结果C组罗哌卡因EC 50为0.26%(0.23%,0.29%),D组为0.22%(0.18%,0.25%),D组显著低于C组(P<0.05)。D组有7例(23%)患者出现心动过缓,高于C组的1例(4%)(P<0.05),予静注阿托品0.5 mg后均恢复正常心率,两组患者均未出现局麻药中毒、低血压、低氧血症、过度镇静等不良反应。结论1μg/kg右美托咪定局部用药可降低罗哌卡因用于糖尿病足患者坐骨神经阻滞的EC 50。Objective To investigate the effect of local application of dexmedetomidine on median effective concentration(EC 50)of ropivacaine for sciatic nerve block in diabetic foot patients.Methods Fifty-seven diabetic foot patients who were undergoing elective unilateral lower limb foot and ankle surgery were divided into two groups:control group(Group C)and dexmedetomidine group(Group D).Both groups underwent ultrasound guided saphenous nerve block combined with popliteal sciatic nerve block.Saphenous nerve block was performed using 0.5%ropivacaine 10 mL,while sciatic nerve block was performed using ropivacaine with 20 mL of ropivacainein Group C,but mixture of ropivacaine and 1μg/kg dexmedetomidine in Group D.The concentration of ropivacaine was determined by up and down sequential trial.The initial concentration was set at 0.5%,and the ratio between the two successive concentration was 1∶1.2,and the capacity was set at 20 mL.If the sensory blockade of the sciatic nerve was complete within 30 minutes after the injection,the dose for the next case reduced by a concentration gradient,otherwise the higher concentration would be applied in the next case.The EC 50 and 95%confidence interval of ropivacaine were calculated.Results The EC 50 and 95%confidence interval of ropivacaine were 0.26%(0.23%,0.29%)in Group C and 0.22%(0.18%,0.25%)in Group D.The EC 50 of ropivacaine was lower in Group D than in Group C(P<0.05).7 patients(23%)in group D had bradycardia,which was higher than that in group C(4%)(P<0.05).All patients returned to normal heart rate after intravenous injection of 0.5 mg atropine.No adverse reactions such as local anesthetic intoxication or hypotension or hypoxemia or excessive sedation were observed in both groups.Conclusion The EC 50 of ropivacaine for sciatic nerve block in diabetic foot patients could be decreased by local application of 1μg/kg dexmedetomidine.

关 键 词：安定镇痛 糖尿病足 神经传导阻滞 半数致死量 

分 类 号：R587.2[医药卫生—内分泌] R614[医药卫生—内科学]