不同剂量右美托咪定对颈丛阻滞下老年锁骨手术患者呼吸及循环的影响

Effect of Different Dosages of Dexmedetomidine on Respiratory and Circulatory Systems of Elderly Patients with Cervical Plexus Block during Clavicle Operation

目的 探讨不同剂量右美托咪定对颈丛阻滞下老年锁骨手术患者呼吸及循环的影响。方法 选择解放军白求恩国际和平医院2012年6月—2014年12月行锁骨手术的老年患者40例,随机分为L和H组,每组20例。颈丛阻滞完成后,L组、H组分别静脉泵注右美托咪定0.5、1.0μg/kg,两组均在15 min内注射完毕。观察记录两组在右美托咪定泵注前（T0）、泵注结束（T1）、切皮即刻（T2）、锁骨探查（T3）和手术结束（T4）时收缩压（SBP）、舒张压（DBP）、心率（HR）、呼吸（R）、脉搏氧饱和度（SpO2）的变化,观察两组窦性心动过缓发生情况。结果 L组和H组在T1-3时SBP、DBP和HR低于T0时（P〈0.05）;H组T1-3时HR低于L组（P〈0.05）。L组窦性心动过缓发生率显著低于H组（P〈0.05）。结论 右美托咪定在老年锁骨手术患者颈丛阻滞中辅助镇静镇痛效果满意,0.5μg/kg术前静注对呼吸循环影响小、安全可靠。

Objective To investigate the effects of different dosages of Dexmedetomidine on respiratory and circulatory systems of elderly patients with cervical plexus block during clavicle operation. Methods A total of 40 elderly patients undergoing clavicle operation during June 2012 and December 2014 were randomly divided into group L （n = 20） and group H （ n = 20）. After cervical plexus block was completed, 0.5 p.g/kg and 1.0 μg/kg Dexmedetomidine were respectively injected for group L and group H via venous pump within 15min. The changes of systolic blood pressure （ SBP）, diastolic blood pressure （DBP） , heart rate （ HR）, respiration （R） and arterial oxygen saturation（ SpO2 ） were observed and recorded before infusion （ T0 ） , at the end of infusion （TI） , at the time of skin incision （ T2 ） , while seeking clavicle （T3 ） and at the end of surgery （T4） in the two groups, and at the incidence rates of sinus bradycardia in the two groups were also observed. Results Levels of SBP, DBP and HR in T1-3 were significantly lower than those at TO in group L and H （ P 〈 0. 05 ） ; HR levels in T1-3 in group H were significantly lower than those in group L （ P 〈 0. 05 ）. The incidence rate of sinus tachycardia in group L was significantly lower than that in group H （P 〈 0. 05 ）. Conclusion Dexmedetomidine assisted with cervical plexus block in sedation and analgesia for elderly patients during clavicle surgery has good effect, and preoperative intravenous infusion with 0.5 μg/kg Dexmedetomidine has little effect on respiratory and circulatory systems with good safety.