右美托咪定腰丛联合坐骨神经阻滞用于老年髋部骨折手术的可行性  

Feasibility of dexmedetomidine for combined lumbar plexus and sciatic nerve blocks in hip fracture surgery in the elderly

作　　者：王春光[1] 陈玉杰[2] 王超[1] 赵晓宝 郭颖[3] 梁浩 王旭伟 WANG Chun-Guang;CHEN Yu-Jie;WANG Chao;ZHAO Xiao-Bao;GUO Ying;LIANG Hao;WANG Xu-Wei(Department of Anesthesiology,Hospital of 82nd Army Group of Chinese PLA,Baoding 071000,Hebei Province,China;Center for Endoscopy,Hospital of 82nd Army Group of Chinese PLA,Baoding 071000,Hebei Province,China;Department of Dermatology,Hospital of 82nd Army Group of Chinese PLA,Baoding 071000,Hebei Province,China;Operating Theater,First Center Hospital of Baoding,Baoding 071000,Hebei Province,China)

机构地区：[1]保定市第一中心医院麻醉科,河北保定071000 [2]保定市第一中心医院内镜中心,河北保定071000 [3]中国人民解放军陆军第八十二集团军医院皮肤科,河北保定071000 [4]保定市第一中心医院手术室,河北保定071000

出　　处：《中华老年多器官疾病杂志》2020年第10期754-758,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：保定市科技计划项目(2041ZF090)。

摘　　要：目的探讨右美托咪定腰丛联合坐骨神经阻滞用于老年髋部骨折手术的可行性。方法60例ASAⅡ或Ⅲ级拟行髋部骨折手术的老年患者按照随机数表法分为2组,分别以0.4%罗哌卡因溶液50 ml(R组)及含0.5μg/kg右美托咪定的0.4%罗哌卡因混合溶液50 ml(RD组)行腰丛联合坐骨神经阻滞,记录2组患者感觉阻滞和运动阻滞的起效时间、持续时间及镇痛时间,记录2组患者的心率(HR)、平均动脉压(MAP)、血氧饱和压(SpO 2)及恶心呕吐、神经损伤、局麻药中毒等不良反应的发生情况。采用SPSS 17.0统计软件对数据进行统计分析。结果与R组相比,RD组感觉阻滞和运动阻滞持续时间延长(P<0.05);RD组镇痛时间明显延长(P<0.05)。与基础值及R组比较,RD组注药后15、30、45及90 min时MAP下降(P<0.05);RD组注药后15、30、45及90 min时HR减慢(P<0.05)。但2组患者均未出现低血压、心动过缓、低氧血症、恶心呕吐、神经损伤及局麻药中毒等不良反应。结论右美托咪定0.5μg/kg混合罗哌卡因腰丛联合坐骨神经阻滞可以明显延长阻滞持续时间及镇痛时间,且不增加心动过缓及低血压等不良反应的发生,可安全有效用于老年患者髋部骨折手术的麻醉。Objective To investigate the feasibility of dexmedetomidine administered locally for lumbar plexus combined with sciatic nerve block in the elderly patients undergoing hip fracture surgery.Methods Sixty patients(ASAⅡ-Ⅲ)undergoing elective hip fractures surgery in the First Center Hospital of Baoding were randomly assigned into group R(0.4%ropivacaine 50 ml for lumbar plexus and sciatic nerve blocks)and group RD(0.4%ropivacaine 50 ml containing dexmedetomidine 0.5μg/kg for lumbar plexus and sciatic nerve blocks).The onset time of sensory and motor block,durations of sensory and motor block and duration of analgesia,mean arterial blood pressure(MAP),heart rate(HR)and SpO 2,and occurrences of adverse reactions,such as nausea and vomiting,nerve injury and poisoning of local anesthetic were observed and recorded.SPSS statistics 17.0 was used to analyze the data.Results Compared with group R,the durations of sensory and motor block,and analgesia were significantly longer in group RD(all P<0.05).At 15,30,45,60 and 90 min after administration,the MAP were obviously decreased and HR were remarkably lower in group RD than the corresponding basic values and those in group R(all P<0.05).However,there were no adverse reactions such as hypotension,bradycardia,hypoxemia,nausea and vomiting,nerve injury and local anesthetic poisoning in both groups.Conclusion Dexmedetomidine of 0.5μg/kg combined with ropivacaine for lumbar plexus and sciatic nerve blocks can significantly prolong the duration of block and analgesia,without increasing the incidence of adverse reactions such as bradycardia and hypotension,and can be safely and effectively used for the anesthesia of hip fracture surgery in elderly patients.

关 键 词：老年人 髋部骨折 右美托咪定 腰丛神经 坐骨神经 

分 类 号：R764.3[医药卫生—耳鼻咽喉科]