右美托咪定对焦虑患者臂丛神经阻滞麻醉操作中焦虑情绪的影响

Effects of dexmedetomidine on dysphoria in anxious patients under brachial plexus anesthesia

目的研究右美托咪定对焦虑患者臂丛神经阻滞麻醉操作中焦虑情绪的影响。方法选择行臂丛神经阻滞麻醉的有焦虑情绪并经焦虑自评量表评估总分>50分的年龄20-60岁、ASAⅠ-Ⅱ级患者60例,采用随机数字表法将其分为2组:右美托咪定(D组,n=30)组和咪达唑仑组(M组,n=30)。D组患者麻醉前右美托咪定总量为1μg/kg持续15 min静脉泵注后进行麻醉操作。M组患者麻醉操作前15 min常规咪达唑仑0.04 mg/kg静注。两组患者均行肌间沟臂丛神经阻滞麻醉。记录并分析入室后(T0)、臂丛神经阻滞麻醉操作时(T1)、手术切皮开始前(T2)Ramsay镇静评分、MAP、HR、SPO2、患者的疼痛刺激反应、谵妄人数及低氧血症需呼吸支持率。结果两组患者T1和T2时点Ramsay镇静评分均高于T0(P<0.05);D组患者T1时点Ramsay镇静评分明显低于M组(P<0.05)。两组患者T2时点MAP、HR均分别低于T0时点(P<0.05),D组T1时点的MAP、HR值低于其T0时点值P<0.05。D组患者观察过程中疼痛刺激体动反应、谵妄及低氧血症需呼吸支持发生率均明显低于M组。结论右美托咪定用于焦虑患者臂丛神经阻滞麻醉操作中可以明显抑制患者的焦虑情绪且无明显呼吸抑制。

Objective To explore the effects of dexmedetomidine on dysphoria in anxious patients under brachial plexus anesthesia. Methods Sixty anxious patients aged 20 -60 years （ASA Ⅰ- Ⅱ）with SAS scores 〉 50 before operation undergoing brachial plexus anesthesia were randomly allocated into midazola group and dexmedetomidine group（ n = 30 in each group）. Patients were intravenously injected by pump with dexmedetomidine 1 μg/kg for 15 min in dexmedetomidine group before anesthesia. Patients in midazolam group were intravenously injected with midazolam 0.04 mg/kg 15 min before anesthesia. Ramsay sedative scores,MAP, HR and SpO2 in both groups were assessed after entering the operation room （T0 ）, during anesthesia （ T1 ） and at skin incision （ T2 ）. The incidences of reac- tion to pain,delirium and hypoxemia were recorded at those time points as well. Results Ramsay sedative scores in both groups at T1 and T2 were higher than that at To （P 〈 0.05）. Ramsay sedative score in dexmedetomidine group at T1 was lower than that in midazolam group （P 〈 0. 05）. The values of MAP and HR in both groups at T2 were lower than those at T0 （ P 〈 0.05）. The values of MAP and HR in dexmedetomidine group at T1 were lower than those at T0 （P 〈 0.05）. The incidences of reaction to pain, delirium and hypoxemia in dexmedetomidine group were lower than those in midazolam group （ P 〈 0.05）. Conclusion Administration of dexmedetomidine could markedly inhibit dysphoria in anxious patients undergoing brachial plexus anesthesia without significant respiratory depression.