右美托咪定混合罗哌卡因用于缓解上肢长时间手术中止血带反应的效果观察

Efficacy of dexmedetomidine mixed with ropivacaine used for relieving tourniquet pain during prolonged upper limp operation

目的：探讨右美托咪定混合罗哌卡因在肌间沟复合腋路臂丛神经阻滞应用于上肢长时间手术中的疗效观察。方法60例急诊断指（多指）、断腕或断臂手术患者，ASAⅠ-Ⅱ级，手术时间8-10 h，随机分配为2组（n =30）：罗哌卡因组（R 组）采用1%罗哌卡因15 mL ＋2%利多卡因10 mL 加生理盐水至40 mL；右美托咪定混合罗哌卡因组（DR 组）采用1%罗哌卡因15 mL＋2%利多卡因10 mL ＋盐酸右美托咪定1μg/ kg 加生理盐水至40 mL。以神经刺激器定位肌间沟臂丛神经分支（腋神经）及腋路臂丛神经主分支（尺神经、桡神经、正中神经和肌皮神经），止血带充气压力200-250 mmHg，压迫时间90 min。观察并记录入室时（T0）、阻滞后1.5 h（T1）、3 h（T2）、4.5 h（T3）、6 h（T4）、7.5 h（T5）、9 h（T6）及术毕（T7）患者的一般生命体征（MAP、HR），同时以VAS 评分法评估患者止血带反应的程度，若无法忍受止血带反应，臂丛加药后试验结束。记录患者止血带耐受情况，并以 Ramsay评分评价 R 组及 DR 组的镇静程度，记录术中出现的不良反应。结果与 R 组相比，DR 组患者对止血带耐受率明显升高，且差异有统计学意义（P ﹤0.05），止血带疼痛时间出现延迟（P ﹤0.05）；与 R 组比较，DR 组 T1- T5时 HR 减慢（P ﹤0.05），DR 组有7例出现窦性心动过缓，两组均未出现止血带严重并发症。结论1μg/ kg 右美托咪定混合1%罗哌卡因对减轻上肢长时间手术带来的止血带疼痛安全、有效，并可延迟止血带疼痛出现的时间。

Objective To observe the clinical efficacy of dexmedetomidine(Dex)mixed with ropivacaine used in brachial plexus block for relieving tourniquet pain during prolonged upper limp operation. Methods 60 cases of patients underwent emergency operation be-cause of severed finger,wrist or arm were randomly divided into two groups:R(n = 30)and DR(n = 30). In the R group,15 ml ropiva-caine(1% )and 10ml lidocaine(2% )and 25 ml normal saline were given. The same anaesthetic dosage as group R and additional Dex (1ug/ kg)were used in the DR group,and the whole dosage amount was 40 ml. All patients applied brachial plexus nerve block through inter- scalene or axilla approach. After the operation began,the tourniquet pressure remained 200 ~ 250 mmHg,then lasting 90 minutes. At the time of beginning(T0)and every 90minutes thereafter(T1 ~ T7)in operation,we recorded the vital signs,including mean arterial pressure (MAP)and heart rate(HR),the adverse reactions in R and DR groups,and further evaluated the level of tourniquet pain and the effect of sedation by the method of VSA and Ramsy scoring,respectively. Results Compared with group R,patients in the DR group had a higher tourniquet pain tolerance rate(P ﹤ 0. 05),and the onset time of tourniquet pain was later(P ﹤ 0. 05). All the cases had no worse tourniquet and cardiovascular complications happened. Conclusion The approach of Dex mixed with ropivacaine used for relieving tourniquet pain dur-ing prolonged upper limp operation is safe and effective,and it can make the tourniquet pain appear later.