摘要
目的:探讨右美托咪定对上肢手术患者超声引导下臂丛神经阻滞(BPB)镇静镇痛效果及血流动力学影响。方法:采用随机数表法,将2019年1月—2021年12月在南京市高淳中医院行上肢手术治疗的120例患者分为D组和C组,各60例。两组均在超声引导下给予1%利多卡因+0.25%罗哌卡因行BPB。D组先静脉泵注右美托咪定1μg/kg,之后给予0.4μg/(kg·h)维持至手术结束前15 min;C组同时间内给予等体积生理盐水泵注。比较两组入室(T_(0))、阻滞后10 min(T_(1))、阻滞后30 min(T_(2))、开展手术后30 min(T_(3))、手术结束即刻(T_(4))各个时间点血流动力学指标[平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O_(2))、呼吸频率(RR)]及Ramsay镇静评分(RSS);于T_(0)、T_(4)时间点比较两组应激激素[去甲肾上腺素(NE)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)]水平变化,并比较两组镇痛效果。结果:T_(0)时间点,两组MAP、HR、Sp O_(2)、RR水平比较差异无统计学意义(P>0.05);T_(1)~T_(4)各时间点,两组MAP、HR、Sp O_(2)、RR水平均降低,但D组MAP、HR、Sp O_(2)、RR降低幅度小于同期C组(P<0.05)。T_(0)时间点,两组Ramsay评分比较差异无统计学意义(P>0.05);T_(1)~T_(4)各时间点,两组Ramsay评分均较T_(0)升高,且D组高于同期C组(P<0.05)。D组中轻度疼痛占比(80.00%)高于C组(60.00%),中度疼痛、重度疼痛占比分别为18.33%、1.67%,均低于C组(33.33%、6.67%);两组镇痛效果比较差异有统计学意义(P<0.05)。T_(0)时间点,两组NE、Cor、ACTH水平比较差异无统计学意义(P>0.05);T_(4)时间点,两组NE、Cor、ACTH水平均升高,但D组升高幅度均小于C组(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:右美托咪定在上肢手术超声引导下BPB中镇痛镇静效果满意,且能减少术中血流动力学波动范围及应激反应,安全性较好,值得临床推广。
Objective:To investigate the effect of Dexmedetomidine on sedation and analgesia and hemodynamics of brachial plexus block(BPB)in patients undergoing upper extremity surgery under ultrasound guidance.Method:Using random number table method,120 patients who underwent upper extremity surgery in Nanjing Gaochun Hospital of Traditional Chinese Medicine from January 2019 to December 2021 were divided into group D and group C,60 cases in each.Both groups were given 1%Lidocaine+0.25%Ropivacaine for BPB under the guidance of ultrasound.Group D was given 1μg/kg Dexmedetomidine intravenously and then0.4μg/(kg·h)until 15 min before the end of surgery.Group C was given equal volume normal saline pump injection at the same time.The hemodynamic indexes[mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(Sp O_(2)),respiratory rate(RR)]and Ramsay sedation score(RSS)at each time point of entering the room(T_(0)),10 min after block(T_(1)),30 min after block(T_(2)),30 min after operation(T_(3)),and immediately after operation(T_(4))between the two groups;the stress hormones[norepinephrine(NE),cortisol(Cor),adrenocorticotropic hormone(ACTH)]levels were compared at T_(0)and T_(4)time points,and the analgesic effects of the two groups were compared.Result:At T_(0),the levels of MAP,HR,Sp O_(2),RR in the two groups were compared,there were no significant differences(P>0.05).T_(1)-T_(4),the levels of MAP,HR,Sp O_(2),RR in the two groups were decreased than T_(0),but the decreases of MAP,HR,Sp O_(2)and RR in group D were less than those in group C at the same period(P<0.05).At T_(0),the Ramsay scores of the two groups were compared,there were no significant differences(P>0.05).T_(1)-T_(4),the Ramsay scores of the two groups were increased than T_(0),and the group D was higher than the group C at the same time(P<0.05).The proportion of mild pain in group D(80.00%)was higher than that in group C(60.00%),and the proportions of moderate pain and severe pain were 18.33%and 1.67%,lower than 33.33%,6.67%in group C;there was significant difference in the analgesic effects of the two groups(P<0.05).At T_(0),the levels of NE,Cor,and ACTH in the two groups were compared,there were no significant differences(P>0.05);at T_(4),the levels of NE,Cor,and ACTH in the two groups were increased,but the increase in group D was smaller than that in group C(P<0.05).The incidence of adverse reactions between the two groups was compared,there was no significant difference(P>0.05).Conclusion:Dexmedetomidine has satisfactory analgesic and sedative effects in BPB guided by ultrasound in upper extremity surgery,and can reduce the range of intraoperative hemodynamic fluctuations and stress response.It is safe and worthy of clinical promotion.
作者
刘赛宇
朱丹萍
LIU Saiyu;ZHU Danping(Nanjing Gaochun Hospital of Traditional Chinese Medicine,Nanjing 211300,China;不详)
出处
《中外医学研究》
2023年第3期19-24,共6页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
上肢手术
超声引导
臂丛神经阻滞
右美托咪定
镇静
镇痛
血流动力学
Upper extremity surgery
Ultrasound guidance
Brachial plexus block
Dexmedetomidine
Sedation
Analgesia
Hemodynamics
