右美托咪定辅助臂丛阻滞联合静脉全麻在肩关节镜手术患者中的效果观察

Effect observation of dexmedetomidine assisted brachial plexus block combined with intravenous general anesthesia in patients with shoulder arthroscopy

目的观察右美托咪定(Dex)辅助行臂丛阻滞(BPB)联合静脉全麻在肩关节镜手术中的麻醉效果。方法选择2019年11月~2021年10月在我院行肩关节镜手术治疗患者92例,按随机数字表法分为观察组和对照组各46例。两组均采用BPB联合全麻,其中观察组在BPB麻醉中给予20 ml的0.4%罗哌卡因+1μg/kg的Dex,对照组在BPB麻醉中给予20 ml的0.4%罗哌卡因。比较两组患者的血流动力学、疼痛程度、瑞芬太尼、丙泊酚用量及不良反应发生情况。结果在气管插管后(T1)、手术结束(T2)时,观察组的心率(HR)、平均动脉压(MAP)均低于对照组(均P<0.05),视觉模拟评分法(VAS)评分、瑞芬太尼用量、丙泊酚用量及苏醒期躁动发生率均低于对照组(均P<0.05)。两组患者的心动过缓、低血压、寒战、胃肠道反应发生率比较,差异无统计学意义(均P>0.05)。结论在肩关节镜手术患者中采用Dex辅助行BPB联合静脉全麻可获得较好的麻醉效果,且对血流动力学的影响小,能有效减轻患者疼痛,减少麻醉药物用量,降低苏醒期躁动发生率,临床应用安全可行。

Objective To observe the anesthesia effect of dexmedetomidine(Dex)assisted brachial plexus block(BPB)combined with intravenous general anesthesia in patients with shoulder arthroscopy.Methods A total of 92 patients who underwent shoulder arthroscopy in Hefei Third People's Hospital from November 2019 to October 2021 were selected and divided into two groups according to the random number table method,with 46 cases in each group.Both groups were treated with BPB combined with general anesthesia.The observation group was given 20 ml of 0.4%ropivacaine+1μg/kg Dex during BPB anesthesia,and the control group was given 20 ml of 0.4%ropivacaine during BPB anesthesia.The hemodynamics,pain level,dosage of remifentanil,propofol and adverse reactions were compared between the two groups.Results After tracheal intubation(T1)and at the end of surgery(T2),the heart rate(HR)and mean arterial pressure(MAP)of the observation group were lower than those of the control group.The dosage of pofol and the incidence of agitation during recovery were lower than those in the control group,with statistical differences(P<0.05 for each);while there was no statistical difference in the incidences of bradycardia,hypotension,chills,and gastrointestinal reactions between the two groups(P>0.05 for each).Conclusion Dex-assisted BPB combined with intravenous general anesthesia can achieve better anesthesia effect in patients with shoulder arthroscopy,which is beneficial to avoid abnormal fluctuations in hemodynamics and relieve postoperative pain.The incidence of agitation is low,and its clinical application is safe and feasible.