右美托咪定联合咪达唑仑辅助臂丛神经阻滞镇静效果

Sedative Effect of Dexmedetomidine Combined with Midazolam During Brachial Plexus Blockade

目的:观察右美托咪定联合咪达唑仑辅助臂丛神经阻滞的镇静效果及安全性。方法:臂丛麻醉择期手术患者80例,随机双盲分为4组,每组20例,咪达唑仑组(A组:咪达唑仑0.04 mg/kg静脉注射+0.9%氯化钠溶液恒速泵入),右美托咪定恒速输注组[B组:右美托咪定0.7μg/(kg·h)恒速泵入],眯达唑仑+右美托咪定恒速输注组[C组:眯达唑仑0.04 mg/kg静脉注射+右美托咪定0.7μg/(kg·h)恒速泵入],右美托咪定负荷量+恒速输注组(D组:负荷量2.5μg/(kg·h)诱导10 min+右美托咪定0.7μg/(kg·h)恒速泵入]。记录静脉给药前(T_0)、给药后10 min(T_1)、20 mm(T_2)、30 min(T_3)、60 min(T_4)及术毕(T_5)各时点的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO_2)、心电图(ECG)和警觉/镇静(OAA/S)评分。结果:与T0MAP、HR和OAA/S评分相比,A组仅T_1下降,差异有显著性(P<0.05);B组T_1-T_5均平稳,差异无显著性(P>0.05);C和D组T_1-T_4均下降,差异有显著性(P<0.05)。4组间T_1-T_4MAP、HR和OAA/S评分比较,A组仅T_1较B组一过性下降,C组和D组均较B组下降,差异有显著性(P<0.05);C组和D组除T_1外均较A组降低,但C组和D组相比,D组较C组下降更明显,差异均有显著性(P<0.05)。四组组内和组间给药前后SPO_2比较,差异均无显著性(P>0.05)。因心率减慢(HR≤45次/min)需给阿托品者,C组1例,D组5例,C组和D组相比,差异有显著性(P<0.05)。结论:右美托咪定联合咪达唑仑辅助臂丛神经阻滞镇静效果满意安全可行。

Objective： To observe the feasibility and safety of dexmedetomidine versus that of midazolam applied in auxiliary sedation during brachial plexus blockade. Methods. Eighty cases of selective surgery patients undergone brachial plexus anesthesia were divided randomly and double-blindly into groups A, B, C, and D, which were anaesthetized by midazolam, micro-pump dexmedetomidine, micro-pump dexmedetomidine combined with midazolam, and the load dose and micro-pump dexmedetomidine respectively. MAP, HR, and OAA/S score were recorded before anesthesia （T0）, 10 min （T1）, 20 min （T2）, 30 min （T3）, 60 min （T4） during anesthesia, and at the end of operation （T5）. Results. Compared with that respectively at To, MAP, HR, and OAA/S score at T1 decreased in group A （P〈0.05）, during T1-T5 in group B were stable （P〉0.05）, and during T1-T4 in group C and group D decreased more apparently （P〈0.05）. While compared with that respectively in group B, MAP, HR, and OAA/S score during anesthesia （T1-T4） decreased in group C and group D （all P〈0.05）, and the decrease of these indices was much more significant in group D than in group C （all P〈0.05）. Conclusion： During brachial plexus blockade,dexmedetomidine combined with midazolam shows satisfying sedative effect, reduces the side effects, and the vital signs of patients during anesthesia are stable.