右美托嘧定复合布托啡诺预防臂丛阻滞止血带反应的疗效观察

Observation on efficacy of dexmedetomidine combined with butorphanol in preventing brachial plexus block tourniquet reaction

目的观察右美托咪定复合布托啡诺预防止血带反应的临床效果。方法选择美国麻醉师协会(ASA)Ⅰ~Ⅱ级,臂丛阻滞效果满意的上肢手术患者50例,分为右美托咪定组(A组)和右美托咪定布托啡诺组(B组),每组25例。A组配制方法:200μg右美托嘧定加生理盐水共50mL;B组:200μg右美托嘧定、1mg布托啡诺、生理盐水共50mL。A组以右美托嘧定1μg/kg负荷15min,继以0.4μg·kg^(-1)·h^(-1)维持至术毕;B组给予0.015 mg/kg布托啡诺后按A组方案给药。记录给药前(T0)、止血带充气毕(T1)、15min(T2)、30 min(T3)、45 min(T4)、60 min(T5)、放气后10 min(T6)各时点VAS评分、BIS值、Ramsay镇静评分、心率(HR)、有创血压(MAP)、脉搏氧饱和度(SPO_2)。评估两组患者主观反应分类计数,以及呼吸抑制、心动过缓、低血压情况。T6时点查血气分析评估pH、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、HCO3-、血乳酸(LAC)。结果两组T4、T5时点VAS评分、BIS值、Ramsay评分、HR、MAP差异有统计学意义(P<0.05);A组主观反应表现为佳和差者分别为9、4例,B组为13、1例,两组比较差异有统计学意义(P<0.05);两组均无呼吸抑制、心动过缓及低血压;血气分析差异无统计学意义(P>0.05);结论右美托咪定复合布托啡诺应用于臂丛麻醉下上肢手术能显著预防止血带反应,效果优于单用右美托咪定。

Objective To observe the clinical effect of dexmedetomidine combined with butorphanol in preventing tourniquet reaction. Methods Fifty patients（ASA Ⅰ-Ⅱ ）with upper limb operation and satisfactory effect of braehial plexus block were ran- domly divided into the dexmedetomidine group（A）and dexmedetomidine combined with butorphanol group （B）, 25 cases in each group. The anesthesia drug preparation method in the group A：dexmedetomidine 200μg was added with normal saline 50 mL;in the group B：dexmedetomidine 200/μg,butorphanol 1 mg and normal saline 50 mL altogether. The group A used dexmedetomidine 1μg/ kg load for 15 rain and maintained by 0.4 μg· kg-1 · h-1 until the end of operation;the group B was given 0. 015 mg/kg butorpha- nol, then was given medication according the scheme of group A. The VAS score,BIS value,Remsay sedation score, HR, MAP and SPOz were recorded at the time points：before medication （T0）,immediately after the tourniquet inflation （T1）, 15 min （T2）, 30 min （T3）,45 rain （T4） ,60 min after tourniquet inflation （T5） and 10 min after deflation （T6）. The subjective response classifica- tion count,respiratory depression, bradycardia and hypotension in the two groups were assessed, pH, PaO2, PaCOz, HCO3- and LAC at T6 were evaluated by the blood gas analysis. Results The VAS score,BIS value, Ramsay sedation score, HR and MAP at T4,T5 had statistical difference between the two groups （P〈0. 05）. In the group A,the good and poor subjective responses had 9 cases and 4 cases respectively,which in the group B had 13 cases and 1 case, the difference was statistically significant （P〈0.05） ; there was no respiratory depression, bradycardia and hypotension in the two groups; the blood gas analysis showed no statistical difference between the two groups. Conclusion Applying dexmedetomidine combined with butorphanol in upper and lower limb surgery under braehial plexus anesthesia can significantly prevent the tourniquet reaction, its effect is superior to single use of dexmedetomidine.