右美托咪定增强甲磺酸罗哌卡因臂丛神经阻滞效果的临床观察

The Clinical Observation of Dexmedetomidine Reinforcement Effect of Axillary Brachial Plexus Block with Ropivacaine Mesylate

目的:本文评价右美托咪定和国产甲磺酸罗哌卡因混合用于臂丛(腋)神经阻滞的效果。方法:将50例拟行前臂或手部手术的病人以随机双盲法分为两组,每组25例。L-组:0.5%甲磺酸罗哌卡因35ml(175mg)+1ml生理盐水,LD-组:0.5%甲磺酸罗哌卡因35ml+1ml右美托咪定(75μg)。监测和记录感觉和运动神经阻滞起效时间、作用时间和镇痛持续时间。结果:LD-组感觉和运动阻滞起效时间短于L-组(P<0.05)。LD-组感觉和运动阻滞持续时间长于L-组(P<0.01和P<0.001)。LD-组在阻滞后30、45、60、90和120min时MAP显著低于L-组(P<0.05)。LD-组HR在阻滞后15、30、45、60、90和120min时显著低于L-组(P<0.05)。LD-组8例(32%)和L-组1例(4%)出现心动过缓使用了阿托品(χ2=4.878 0,P<0.05)。结论:右美托咪定加入甲磺酸罗哌卡因中用于腋路臂丛神经阻滞,可缩短起效时间、延长阻滞和术后镇痛时间,同时可导致心动过缓。

Objective：The aim of this study was to evaluate the effect of adding dexmedetomidine to Roplvacaine Mesy late for axillary brachial plexus blockade. Methods： 50 patients scheduled for elective forearm and hand surgery were di- vided into 2 equal groups in a randomized,double-blind fashion. In group L （n=25） ,35ml （175mg） of 0. 5% Ropivacaine Mesylate＋lml saline and in group LD（n=25） ,35ml of 0.5% Ropivacaine Mesylate＋lml（75μg） dexmedetomi- dine were given. Motor and sensory block onset times,block durations, and duration of analgesia were recorded. Re- suits：Demographic data and surgical characteristics were similar in both groups. Sensory and motor block onset times were shorter in group LD than in group L（P〈0.05）. Sensory and motor blockade durations were longer in group LD than in group L（P〈0.01and P〈0. 001）. Duration of analgesia was longer in group LD than in group L（P〈0. 001）. MAP levels in group LD at 30,45,60,90 and 120 minutes were significantly lower than those in group L（P〈0. 05）. Heart rate levels in group LD at 15,30,45,60,90 and 120 minutes were significantly lower than those in group L（P〈 0. 05）. In group LD bradycardia was observed in 8 patients, and 1 patient in group L（P〈0. 05）. Conclusion： Dexme- detomidine added to ropivacaine mesylate for axillary brachial plexus block shortens the onset time and prolongs the du ration of the block and the duration of postoperative analgesia. However, dexmedetomidine also may lead to bradyca rdia.