肥胖患者按不同体重标准使用右美托咪啶防治上肢止血带反应的对比研究

Effect of different dosing scalar for dexmedetomidine on tourniquet-related discomfort in upper limb of obese patients under brachial plexus block anesthesia

目的观察肥胖患者按不同体重标准使用右美托眯啶防治上肢止血带反应的疗效。方法将78例择期行上肢手术患者按随机数字表法分为右美托眯啶按总体重给药组(D1组)、按去脂体重给药组(D2组)和对照组(C组),每组26例。臂丛神经阻滞后,D1、D2组分别按总体重和去脂体重给予右美托咪啶负荷剂量1μg/kg,继之以0.4μg/(kg·h)持续输注至手术结束前30min,对照组予等量0.9%氯化钠溶液。记录3组患者止血带反应发生例数、止血带反应程度、止血带反应发生时间、术中辅助芬太尼用量;麻醉期间不良反应发生情况。结果与C组相比,D1、D2组术中止血带反应程度减轻,止血带反应发生时间延长,辅助芬太尼用量减少(均P<0.05);D1、D2组间止血带反应程度、止血带反应发生时间、术中铺助芬太尼用量比较差异均无统计学意义(均P>0.05);D1、D2、C组发生不良反应例数分别为12例(46.2%)、4例(15.4%)、7例(26.9%),D1组不良反应发生率比D2组高(P<0.05),与D2组相比,D1组窦性心动过缓发生例数增多(P<0.05)。结论对肥胖患者,右美托眯啶按去脂体重给药可有效减少上肢手术的止血带反应,且与按总体重给药者相比,不良反应明显减少。

Objective To investigate the effect of different dosing scalar for dexmedetomidine on tourniquet-related discomfort in upper limb of obese patients under brachial plexus block anesthesia. Methods Seventy eight patients undergoing elective upper limb surgery under brachial plexus block anesthesia were enrolled in this study. The patients were randomly divid- ed into 3 groups with 26 cases in each group. In group D1 and D2, 1 μ g/kg dexmedetomidine was given after brachial plexus block, followed by continuous infusion of 0.4μg/kg/h until the end of surgery; The doses of dexmedetomidine were calculated according to total body weight or lean body weight, respectively. Meanwhile same volume of normal saline was given to patients in group C. The number of patients with tourniquet-related discomfort, the intensity and duration of tourniquet-related discomfort, consumption of fentanyl and adverse reactions during anesthesia were recorded. Results Compared to group C, the intensity and duration of tourniquet-related discomfort and the consumption of fentanyl were decreased in groups D1 and D2 （P〈0.05）. There was no significant difference in the intensity and duration of tourniquet-related discomfort and the consumption of fentanyl between groups D1 and D2 （P 〉0.05）. Compared to group D2, the incidence of bradycardia significantly increased in group D1 （P〈0.05）. Conclusion Lean bodyweight is the optimal dosing scalar in the administration of dexmedetomidine for obese patients under brachial plexus block.