右美托咪定辅助股神经、坐骨神经联合阻滞对下肢止血带应用的影响

Effect of dexmedetomidine combined with femoral nerve and sciatic nerve block on tourniquet application in lower limb surgery

目的观察右美托咪定辅助股神经、坐骨神经联合阻滞麻醉在下肢手术时止血带部位镇痛及全身镇静效果。方法采用前瞻性双盲随机对照研究的方法,选取2020年1月至2020年12月在唐山市第二医院拟行下肢手术(急诊和择期手术)的患者80例,采用计算机随机方法随机分为右美托咪定组(A组)和对照组(B组)。A组在股神经、坐骨神经联合阻滞麻醉成功后用微量泵泵入右美托咪定,B组给予等剂量安慰剂对照。观察记录两组患者的心率、平均动脉压(mean arterial pressure,MAP)、呼吸频率、血氧饱和度(oxygen saturation,SpO2)的变化,主要观察指标为术中镇静效果(Ramsay评分)以及止血带部位疼痛评分[视觉模拟评分(visual analogue scale/score,VAS)]。结果术中最高Ramsay评分A组4(4,4)分,B组2(2,3)分,差异有统计学意义(Z=7.339,P<0.001),术中最低Ramsay评分A组2(2,2)分,B组1(1,1)分,差异有统计学意义(Z=7.304,P<0.001)。术中VAS评分A组0(0,1)分,B组8(7,8)分,差异有统计学意义(Z=6.610,P<0.001)。心率最低值A组为(58.1±5.5)次/min,B组为(70.0±10.6)次/min;心率最高值A组为(85.2±7.1)次/min,B组为(98.1±11.0)次/min,差异均有统计学意义(t值分别为14.453、4.038,P值分别P<0.001、0.048)。MAP最低值A组为(80.3±6.0)mmHg,B组为(92.1±4.2)mmHg,差异有统计学意义(t=5.009,P=0.028),MAP最高值、呼吸频率最低值、SpO2最低值A、B组比较差异均无统计学意义(P均>0.05)。结论股神经、坐骨神经阻滞麻醉联合静脉辅助右美托咪定,可以有效缓解下肢止血带长时间应用的不适感。

Objective To investigate the effect of dexmedetomidine on alleviating tourniquet pain for lower limb surgery under femoral nerve combined with sciatic nerve block and effect of systemic sedation.Methods A prospective double-blind randomized controlled study was conducted.From January 2020 to December 2020,80 patients who scheduled for lower extremity surgery(emergency and elective surgery)in The Second Hospital of Tangshan were randomly divided into dexmedetomidine group(group A)and control group(group B).Dexmedetomidine was used through i.v.pump in group A after successful femoral nerve and sciatic nerve block,and the same volume saline was given to group B.The changes of heart rate,mean arterial pressure(MAP),respiratory rate and oxygen saturation(SpO2)in the two groups were observed and recorded.The main observation indexes were intraoperative sedation(Ramsay score)and tourniquet pain score(VAS score).Results The highest Ramsay score was 4(4,4)in group A,2(2,3)in group B,the difference was statistically significant(Z=7.339,P<0.001).The lowest Ramsay score was 2(2,2)in group A and 1(1,1)in group B,The difference was statistically significant(Z=7.304,P<0.001).Intraoperative VAS score was 0(0,1)in group A and 8(7,8)in group B,the difference was statistically significant(Z=6.610,P<0.001).The lowest HR was(58.1±5.5)times per minute in group A and(70.0±10.6)times per minute in group B;The highest HR was(85.2±7.1)times per min in group A and(98.1±11.0)times per minute in group B(t values were 14.453 and 4.038,respectively;and P values were<0.001 and 0.048,respectively).The lowest value of MAP was(80.3±6.0)mmHg in group A and(92.1±4.2)mmHg in group B(t=5.009,P=0.028),there was no significant difference in the highest value of MAP,the lowest value of RR and the lowest value of SpO2 between groups A and B(all P>0.05).Conclusion Intravenous dexmedetomidine combined with femoral nerve and sciatic nerve block can effectively alleviate the discomfort of long-term application of lower limb tourniquet.