右美托咪定在超声引导臂丛神经阻滞下行上肢骨折手术中的应用  

Application of Dexmedetomidine during Operation of Upper Limb Fracture under Ultrasound-Guided Brachial Plexus Nerve Block

作　　者：刘娟[1] 王庆宝[2] 顾仕贤[2] LIU Juan;WANG Qingbao;GU Shixian(Anesthesiology Department,Brain Hospital of Nanjing Medical University,Nanjing 210029,China;Anesthesiology Department,Nanjing Jiangbei People's Hospital,Nanjing 210048,China)

机构地区：[1]南京脑科医院麻醉科,江苏省南京市210029 [2]南京江北人民医院麻醉科,江苏省南京市210048

出　　处：《组织工程与重建外科杂志》2020年第6期505-508,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的研究右美托咪定在超声引导臂丛神经阻滞下行上肢骨折手术中的应用效果。方法自2017年6月至2019年3月,共纳入60例上肢骨折手术患者,随机分成研究组和对照组,每组各30例。两组患者均接受超声引导臂丛神经阻滞,其中对照组给予罗哌卡因,研究组给予罗哌卡因加右美托咪定泵注。比较两组患者的感觉、运动阻滞的起效时长、维持时长,在麻醉前(T1)、麻醉时(T2)、手术结束时(T3)时的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),术后初次疼痛时间、镇痛维持时长、视觉模拟评分(VAS)、满意度评分以及不良反应发生率。结果研究组感觉、运动阻滞的起效时长、维持时长均优于对照组(P<0.05)。T1时,两组MAP、HR、SpO2均无显著差异(P>0.05);T2、T3时,除SpO2之外,研究组MAP、HR均优于对照组(P<0.05).研究组术后初次疼痛时间、镇痛维持时长、VAS、满意度评分均优于对照组(P<0.05)。研究组不良反应发生率为6.67%,对照组为13.33%,无统计学差异(P>0.05)。结论右美托咪定运用于超声引导臂丛神经阻滞下的上肢骨折手术中,能够稳定患者生命体征,防止应激反应产生,同时改善运动与感觉阻滞状况,促进术后疼痛快速消失,患者满意度高,值得推广。Objective To explore the efficacy of dexmedetomidine during operation of upper limb fracture under ultrasoundguided brachial plexus nerve block.Methods From June 2017 to March 2019,60 patients with upper limb fracture were selected,and were divided into study group and control group according to random stratification method,with 30 cases in each group.During ultrasound-guided brachial plexus nerve block,the control group took ropivacaine,while the study group took ropivacaine and intravenous pumping of dexmedetomidine.Onset time and maintenance duration of sensory and motion blocking,MAP(mean arterial pressure),HR(heart rate)and SpO2(oxygen saturation)values at T1(before anesthesia),T2(upon anesthesia)and T3(after surgery),postoperative initial pain time,analgesia duration,VAS(visual analogue scale)scores,treatment satisfaction scores and incidence of adverse reactions were compared.Results The onset time and maintenance duration of sensory and motion blocking in the study group were better than those in control group(P<0.05);At T1,MAP,HR and SpO?levels of the two groups showed no significant difference(P>0.05);At T2 and T3,MAP and HR values of the study group were better than those of the control group(P<0.05).Postoperative initial pain time,analgesia duration,VAS scores and treatment satisfaction scores in the study group were all better than those in the control group(P<0.05).The incidence of adverse reactions was 6.67%in the study group and 13.33%in the control group,with no statistical difference(P>0.05).Conclusion During ultrasound-guided brachial plexus nerve block for operation of upper limb fracture,dexmedetomidine can stabilize patient's vital signs,prevent the stress response,improve the sensory and motion blocking conditions,relieve the postoperative pain and increase the treatment satisfaction.It is worthy of promotion.

关 键 词：上肢骨折手术 右美托咪定 超声 臂丛神经阻滞 

分 类 号：R614.4[医药卫生—麻醉学]