右美托咪定复合左布比卡因用于颈丛阻滞麻醉的临床观察

Clinical observation of Dexmedetomidine combined with Levobupivacaine for cervical plexus block anesthesia

目的观察右美托咪定复合左布比卡因行颈丛神经阻滞麻醉的临床效果。方法拟择期行甲状腺腺瘤切除手术的患者60例随机分为两组,对照组(L组):0.25%左布比卡因加注射用生理盐水1 mL;右美托咪定组(LD组):0.25%左布比卡因加右美托咪定1 mL(100μg)。记录患者基础收缩压、舒张压和心率(T0)及颈丛阻滞后5 min(T1)、10 min(T2)、切皮(T3)、分离甲状腺上极(T4)、缝皮(T5)、阻滞后120 min(T6)时的收缩压、舒张压和心率。观察感觉阻滞起效时间、感觉阻滞持续时间、镇痛持续时间及不良反应(低血压、心动过缓、低氧血症、恶心呕吐)的发生率。结果感觉阻滞起效时间LD组短于L组(P<0.05)。感觉阻滞持续时间LD组明显长于L组(P<0.01)。镇痛持续时间LD组长于L组(P<0.05)。L组T1、T2、T3、T4、T5的MAP较T0升高,差异有统计学意义(P<0.05);T2、T3、T4的MAP明显升高(P<0.01)。LD组只有T1的MAP较T0升高(P<0.05)。L组T2、T3、T4、T5的MAP均高于LD组(P<0.05);且T3、T4的MAP明显高于LD组(P<0.01)。L组T1、T2、T3、T4、T5的HR较T0明显增快(P<0.01),LD组只有T1的HR较T0增快(P<0.05)。L组T2、T3、T4、T5的HR均高于LD组(P<0.05);尤其T2、T3、T4的HR明显高于LD组(P<0.01)。结论左布比卡因注射液中加入100μg右美托咪定行颈丛阻滞,可缩短麻醉起效时间,缓解颈丛阻滞所致循环波动及术中应激反应,延长麻醉作用时间及镇痛时间,使患者更舒适,从而提高了颈丛阻滞的可靠性和安全性。

Objective To evaluate the effect of adding Dexmedetomidine to Levobupivacaine for cervical plexus blockade.Methods Sixty patients for elective thyroid surgery were divided into 2 groups in a randomized,double-blind fashion.In group L,0.25% Levobupivacaine ＋ 1 mL saline and in group LD,0.25% Levobupivacaine ＋ 1 mL Dexmedetomidine were given.Sensory block onset times,block durations,and duration of analgesia were recorded.And at entering the operation room（T0）,5 min,10 min after cervical anesthesia（T1,T2）,at incision（T3）,separation of thyroid upper extreme（T4）,suture（T5）,120 min after cervical anesthesia systolic pressure（SBP）,diastolic pressure（DBP） and heart rate（HR） were delected.Results Demographic data and surgical characteristics were similar in both groups.Sensory block onset time was shorter in group LD than in group L（P 0.05）.Sensory block durations was longer in group LD than in group L（P 0.01）.Duration of analgesia was longer in group LD than in group L（P 0.05）.MAP in group L at T1,T2,T3,T4,T5 were higher than at T0（P 0.05）,especially at T2,T3,T4（P 0.01）.MAP in group LD only at T1 was higher than at T0（P 0.05）.MAP in group L at T2,T3,T4,T5 were higher than those in group LD（P 0.05）,especially at T3,T4（P 0.01）.HR in group L at T1,T2,T3,T4,T5 were significantly higher than at T0（P 0.01）.HR in group LD only at T1 was higher than at T0（P 0.05）.HR in group L at T2,T3,T4,T5 were higher than those in group LD（P 0.05）,especially at T2,T3,T4（P 0.01）.Conclusion Dexmedetomidine add to Levobupivacaine for cervical plexus block shortens the onset time,can prolongs the duration of the block and the duration of postoperative analgesia and efficiently inhibits cardiovascular effects.