右美托咪定联合罗哌卡因对颈丛神经阻滞的影响

Effect of dexmedetomidine with ropivacaine on cervical plexus block

目的探讨不同剂量右美托咪定联合罗哌卡因对颈丛神经阻滞的影响。方法将颈丛神经阻滞下行甲状腺良性肿瘤切除术的90例患者分为3组:0.375%罗哌卡因20 m L(R组)、0.375%罗哌卡因20 mL+右美托咪定0.5μg/kg(D1组)、0.375%罗哌卡因20 mL+右美托咪定0.75μg/kg(D2组)。记录麻醉前(T1)、颈丛神经阻滞后10 min(T2)、手术开始(T3)、分离甲状腺上极(T4)、手术结束(T5)的平均动脉压、心率和Ramsay镇静评分,观察感觉阻滞起效时间及持续时间、镇痛持续时间和不良反应发生率。结果在T2、T3、T4和T5时,D1、D2组的平均动脉压低于R组、心率慢于R组(P <0.05)。在T2、T3、T4和T5时,D1、D2组的Ramsay评分大于R组(P <0.05)。感觉阻滞起效时间D1、D2组短于R组,D2组短于D1组(P <0.05)。感觉阻滞持续时间D1、D2组长于R组,D2组长于D1组(P <0.05)。镇痛持续时间D1、D2组长于R组,D2组长于D1组(P <0.05)。结论 0.75μg/kg右美托咪定联合罗哌卡因可明显改善颈丛神经阻滞效果,安全性好。

Objective To investigate the efficacy of dexmedetomidine with different doses combined with ropivacaine on cervical plexus block.Methods Ninety patients scheduled for resection of thyroid benign tumor with cervical plexus block were randomly divided into group R,group D1 and group D2.Group R was treated with 0.375%ropivacaine 20 mL;group D1 with 0.375%ropivacaine 20 mL plus dexmedetomidine 0.5μg/kg and group D2 with 0.375%ropivacaine 20 mL plus dexmedetomidine 0.75μg/kg.Mean arterial pressure(MAP),heart rate(HR)and Ramsay score were monitored before block anesthesia(T1),10 minutes after block anesthesia(T2),at the beginning of operation(T3),separation of thyroid upper extreme(T4)and at the end of operation(T5).Sensory block onset time,duration of sensory block,duration of analgesia and adverse reaction were observed.Results MAP was lower and HR was slower in group D1 and D2 than those in group R at T2,T3,T4 and T5(P<0.05).The Ramsay score of group D1 and group D2 was higher than that of group R at T2,T3,T4 and T5(P<0.05).Sensory block onset time was shorter in group D1 and D2 than that in group R,and that in group D2 was shorter than that in group D1(P<0.05).The duration of sensory block was longer in group D1 and D2 than that in group R,and that in group D2 was longer than that in group D1(P<0.05).The duration of analgesia was longer in group D1 and D2 than that in group R,and that in group D2 was longer than that in group D1(P<0.05).Conclusion With good safety,0.75μg/kg dexmedetomidine combined with ropivacaine can significantly improve the effect of cervical plexus block.