臂丛神经阻滞中右美托咪定的辅助镇痛效果研究

Dexmedetomidine in Brachial Plexus Block for the Upper Extremity Fracture Surgery

目的:探讨右美托咪定在前臂骨折手术臂丛神经阻滞中的作用。方法:选择69例前臂骨折患者,手术均采用臂丛神经阻滞。纳入患者被随机分为三组,分别采用右美托咪定(A组)、咪达唑仑(B组)和安慰剂(生理盐水、C组),比较三组不同时间点心率(HR)、平均动脉压(MAP)、呼吸频率(RR),记录三组患者手术前后的VAS评分并统计分析。结果:A组中随着麻醉和手术进展,心率、平均动脉压逐渐下降,在手术开始时、复位操作和手术结束时心率、平均动脉压均显著低于C组。B组患者于手术切皮时和复位操作时的呼吸频率较基础值显著降低,并且显著低于A组和C组(P均<0.05)。A组、B组患者在手术开始前、手术结束时、手术后30min的VAS评分均显著低于C组(P均<0.05),C组芬太尼使用量显著高于A组和B组(P均<0.05)。结论:右美托咪定能有效地达到臂丛神经阻滞下前臂骨折手术的辅助镇痛效果,值得临床应用并推广。

Objective： To investigate the effect of dexmedetomidine in brachial plexus block for upper extremity fractures. Method： 69 cases of patients with upper extremity fractures undertaken brachial plexus surgery were collected. Patients were divided into three groups,namely the usage of dexmedetomidine（ group A）,midazolam（ group B） and placebo（ saline,group C）. Heart rate（ HR）,mean arterial pressure（ MAP） and respiratory rate（ RR） in different points of time were compared in three groups. VAS scores before and after surgery in three groups were recorded and statistical analysis was taken. Result： With the progress of anesthesia and surgery,heart rate and mean arterial pressure in group A were decreased at the beginning of surgery,reset operation and at the end of surgery were significantly lower than group C. At the surgical incision and reset operation in group B,respiratory rate was significantly reduced compared to baseline values,and significantly lower than in group A and group C（ P 0.05）. Before surgery,at the end of surgery and 30 min after surgery,VAS scores in group A,group B were significantly lower than group C（ P 0.05）. The amount of fentanyl in group C was significantly higher than group A and group B（ P 0. 05）.Conclusion： Dexmedetomidine may effectively achieve assisted therapy in brachial plexus block analgesia for upper extremity fractures surgery,It＇s worthy of clinical application and promotion.