地塞米松复合右美托咪定对臂丛神经阻滞效果的影响

Influence of dexamethasone combined with dexmedetomidine on interscalene brachial plexus block

目的观察地塞米松复合右美托咪定对肌间沟臂丛神经阻滞效果的影响。方法将在肌间沟臂丛神经阻滞下行上肢骨折手术患者60例随机分为3组各20例,其中C组给予0.5%罗哌卡因,D组给予0.5%罗哌卡因+右美托咪定1μg/kg,DD组给予0.5%罗哌卡因+右美托咪定1μg/kg+地塞米松10mg,药液均为25mL。分别于入室时(T0)、手术开始时(T1)、手术开始30min时(T2)和手术结束时(T3)记录患者心率(hear rate,HR)、平均动脉压(mean arterial pressure,MAP)、脉搏氧饱和度(oxygen saturation,SpO2)、OAA/S评分,并记录感觉和运动神经阻滞起效时间、持续时间及心血管事件、过度镇静、恶心呕吐等不良反应。结果 3组OAA/S评分、HR组间、时点间差异有统计学意义(P<0.05),而组间·时点间交互作用差异无统计学意义(P>0.05);3组MAP时点间差异有统计学意义(P<0.05),而组间与组间·时点间交互作用差异无统计学意义(P>0.05);3组SpO2组间、时点间、组间·时点间交互作用差异均无统计学意义(P>0.05)。与C组比较,D和DD组感觉和运动神经阻滞起效时间缩短,持续时间延长(P<0.05);与D组比较,DD组感觉和运动神经阻滞持续时间延长(P<0.05)。DD组恶心呕吐发生率低于D组。D组和DD组少数患者出现窦性心动过缓。结论地塞米松复合右美托咪定可以增强罗哌卡因的镇痛效果,缩短起效时间,延长作用时间,减少不良反应,但可能诱发心动过缓。

Objective To observe the effects of dexamethasone combined with dexmedetomidine on interscalene brachial plexus block.Methods Sixty patiens scheduled for upper extremity surgery with interscalene brachial plexus block were randomly divided into three groups,with 20 cases in each group.Control group（group C）was given 0.5% ropivacaine 25mL;Dexmedetomidine group（group D）was received 0.5% ropivacaine＋1μg/kg dexmedetomidine 25mL;dexamethasone combined with dexmedetomidine group（group DD）was injected with 0.5%ropivacaine＋1μg/kg dexmedetomidine and dexamethasone 10 mg 25mL.Hear rate（HR）,mean arterial pressure（MAP）,oxygen saturation（SpO2）and OAA/S score at the time of entering the operating room（T0）,beginning of the operation（T1）,30 min after the start of operation（T2）,at the end of the surgery（T3）were observed.The onset time and duration of sensory and motor block were recorded.The adverse effects such as adverse cardiovascular events,excessive sedation,nausea and vomiting were also recorded.Results The difference in OAA/S score and HR,interblock and time dissimilarity in the three groups at the groups and time points were statistically significant（P〈0.05）.However,there was no significant difference in the interactionbetween group and time（P〈0.05）.In OAA/S score and HR,interblock and time dissimilarity of the three groups had statistically significant difference.There was no significant difference in interaction of interblock with time dissimilarity between the three groups.For MAP,there were statistically significant differences in time dissimilarity among the three groups（P〈0.05）.There was no significant difference in interblock and interaction of interblock with time dissimilarity between the three groups（P〈0.05）.For SpO2,there was no significant difference among the three groups（P〈0.05）.Compared with group C,the onset time was（P〈0.05）.Compared with group C,the onset time was significantly shortened,and the duration of block was prolonged（P〈0.05）in group D and group DD.Compared with groups D,the duration of block was prolonged in groups DD（P〈0.05）.The incidence of nausea and vomiting in group DD was significantly lower than in group D.Some patients developed bradycardia in groups D and DD.Conclusion Dexamethasone combined with dexmedetomidine can enhance the analgesic effect of ropivacaine,shorten the onset time,prolong the action time,reduce the adverse reactions,but may induce bradycardia.