右美托咪定用于辅助臂丛神经阻滞麻醉的效果观察

Effects of the dexmedetomidine(Dex) applied in Brachial plexus block

目的观察右美托咪定用于辅助臂丛麻醉时的镇静效果。方法选择60例ASAⅠ～Ⅱ级的上肢手术患者,随机均分为两组。右美托咪定组(D组)和对照组(C组)。D组在臂丛阻滞成功后用微量泵泵注右美托咪定,C组不注射任何药物。观察记录两组患者的镇静效果(Ramsay评分)、HR(心率)、MAP(平均动脉压)、RR(呼吸)、SpO2的变化以及术后对手术操作的遗忘程度。结果D组患者镇静评分显著高于C组(P<0.05);MAP(T1～T5观察点)和HR(T1～T5观察点)均低于C组(P<0.05);RR和SpO2两组间比较没有显著差异(P>0.05);对手术操作的遗忘程度D组显著高于C组(P<0.01)。结论右美托咪定辅助臂丛神经阻滞麻醉时,在手术开始前缓慢(≥10 min)静脉泵注负荷剂量0.8μg.kg-1,继以小剂量0.2μg.kg-1.h-1维持,具有良好的镇静作用,可有效地抑制心血管反应,并可产生良好的术后遗忘作用,且无呼吸抑制,其安全性高,具有一定的推广价值。

Objective To observe the sedative effect of Dex when it was applied in brachial plexus block.Methods 60 patients（ASA I or II） were randomly divided into 2 groups：Dex group（group D） and control group（group C）.After brachial plexus block,the patients of group D were injected Dex by a micro pump,the group C were not injected with any medicine.We observed and recorded all patients with Ramsay score,the changes of HR（heart rate）,MAP（mean arterial pressure）,RR（respiratory）,SpO2,and the oblivion extent of surgical operation.Results In group D,the sedation score was higher than that in group C（P0.05）;HR（T1~T5 observation points） and MAP（T1~T5 points） were lower than those in group C（P 0.05）;RR and SpO2 between the two groups had no significant differences.In group D the operation of the oblivion extent score was also higher than that in group C（P 0.01）.Conclusion Before the operation,Dex loading dose of 0.8 μg·kg-1 was injected by a micro pump,followed by small dose of 0.2 μg·kg-1·h-1,auxiliary for brachial plexus block,has good sedative effect,can effectively inhibit cardiovascular responses,and produce good postoperative amnesia,without respiratory depression,It is safe and can be widely applied.