不同剂量右美托咪定联合罗哌卡因对臂丛神经阻滞效果的影响

Influence of different dose of Dexmedetomidine combined with Ropivacaine on brachial plexus block effect

目的探讨不同剂量右美托咪定联合罗哌卡因对臂丛神经阻滞效果的影响。方法选取2017年1~12月在我院择期行上肢手术的105例患者作为研究对象,采用随机数字表法将其分为三组,各35例。观察1组患者用100μg右美托咪定联合40 ml罗哌卡因(0.375%),观察2组用50μg右美托咪定联合40 ml罗哌卡因(0.375%),对照组患者用40 ml罗哌卡因(0.375%),比较三组的阻滞起效时间、阻滞持续时间、疼痛及镇痛情况、皮质醇浓度以及麻醉安全性。结果观察1组患者的感觉神经和运动神经阻滞起效时间均短于观察2组和对照组,阻滞持续时间均长于观察2组和对照组,差异有统计学意义(P<0.05)。观察1组患者的首次疼痛时间、术后镇痛时间明显短于观察2组、对照组,首次疼痛评分明显低于其余两组,差异有统计学意义(P<0.05)。三组患者的皮质醇浓度在神经阻滞10 min、手术开始时明显高于麻醉开始前,观察1组神经阻滞10 min、手术开始时的皮质醇浓度低于观察2组,观察2组低于对照组,差异有统计学意义(P<0.05)。三组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论上肢手术患者用100μg右美托咪定联合40 ml罗哌卡因(0.375%)进行臂丛神经阻滞可改善臂丛神经阻滞效果,兼具安全性和有效性,具有临床应用优势。

Objective To explore the influence of different dose of Dexmedetomidine combined with Ropivacaine on brachial plexus block effect. Methods A total of 105 patients with selective upper extremity surgery in our hospital from January to December 2017 were selected as the study subjects, and they were divided into the three groups,and there were 35 cases in each group according to the random number table method. Patients in the observation group 1 were treated with 100 μg Dexmedetomidine combined with 40 ml Ropivacaine（0.375%）, patients in the observation group 2 were treated with 50 μg Dexmedetomidine combined with 40 ml Ropivacaine（0.375%）, and the control group was treated with 40 ml Ropivacaine（0.375%）. The time to block onset, duration of block, pain and analgesia, cortisol concentration, and safety of anesthesia were compared among the three groups. Results The onset time of sensory nerve and motor nerve block in the observation group 1 were shorter than those in the observation group 2 and the control group, and the duration of block in the observation group 1 were longer than those in the observation group 2 and the control group, and the differences were statistically significant（P〈0.05）. The first pain time and postoperative analgesia time in the observation group 1 were shorter than those in the observation group 2 and the control group, and the first pain score of the observation group 1 was lower than that in the observation group 2 and control group, and the difference was statistically significant（P〈0.05）. The cortisol concentration at nerve block 10 min and at the beginning of the operation in the three groups were significantly higher than those before onset of anesthesia, and the cortisol concentration at nerve block 10 min and at the beginning of the operation in the observation group 1 were lower than those in the observation group 2, and the observation group 2 was lower than those of the control group, and the difference was statistically significant（P〈0.05）. There was no significant difference in the total incidence of adverse reactions among the three groups（P〉0.05）. Conclusion Brachial plexus block with 100 mg Dexmedetomidine combined with 40 ml Ropivacaine（0.375%） applied in patients with upper extremity surgery can improve the effect of brachial plexus block,and is safe and effective. It has the advantage of clinical application.