右美托咪定静脉麻醉复合臂丛神经阻滞在上肢手术中的应用

Application of Dexmedetomidine Intravenous Anesthesia Combined with Brachial Plexus Block in Upper Limb Surgery

目的 探讨上肢骨折手术患者采取右美托咪定静脉麻醉复合臂丛神经阻滞的效果与安全性。方法抽选2020年1月-2022年1月南通市第三人民医院收治的上肢骨折患者60例进行回顾性研究,所有患者均接受手术治疗,根据入院时间先后顺序划分对照组(2020年1月-2020年12月,30例)与观察组(2021年1月-2022年1月,30例)。对照组患者单纯采取臂丛神经阻滞麻醉,观察组采取右美托咪定静脉麻醉复合臂丛神经阻滞麻醉,监测比较两组患者手术期间不同时间血压、心率、血氧饱和度水平变化,比较两组患者麻醉质量(麻醉起效用时、完全阻滞用时、维持镇痛用时),观察统计各组患者术后不良反应发生情况与总概率。结果 术前两组患者监测血压、心率、血氧饱和度指标结果比较无统计学差异(P>0.05),麻醉10min、30min及手术结束时,观察组患者血压高于对照组,心率低于对照组,差异无统计学意义(P<0.05),两组患者术中各时间节点血氧饱和度比较无统计学差异(P>0.05)。观察组患者麻醉起效及完全阻滞用时均短于对照组,维持镇痛时间长于对照组(P<0.05)。两组患者术后出现不良反应的总概率比较无统计学差异(P>0.05)。结论 临床开展上肢手术期间,首选右美托咪定静脉麻醉复合臂丛神经阻滞,具有较好麻醉质量,同时对患者血压、心率等影响低,安全性高,值得运用推广。

Objective To investigate effect and safety of intravenous anesthesia with dexmedetomidine combined with brachial plexus block for patients with upper limb fracture surgery.Methods The paper reviewed and studied 60 cases upper limb fracture patients with surgical treatment admitted to Nantong City the Third People's Hospital from January 2020 to January 2022,and divided them into control group(January 2020 to December 2020,30 cases)and observation group(January 2021 to January 2022,30 cases)according to admission sequence.Control group was treated with brachial plexus block anesthesia,while observation group with intravenous anesthesia combined with dexmedetomidine brachial plexus block anesthesia.Changes in blood pressure,heart rate,and blood oxygen saturation levels were monitored and compared between two groups at different times during surgery,anesthetic quality between two groups(anesthetic onset time,complete block time,and maintenance analgesia time)was compared,and occurrence and total incidence of adverse reactions between groups after surgery was observed and counted.Results There was no significant difference in blood pressure,heart rate,and blood oxygen saturation between two groups before surgery(P>0.05).At the end of anesthesia for 10 minutes,30 minutes,and end of surgery,blood pressure in observation group was higher than control group,while heart rate was lower than control group,with no significant difference(P<0.05).There was no significant difference in blood oxygen saturation between two groups at various time points during surgery(P>0.05).Duration of anesthesia onset and complete block in observation group was shorter than control group,and duration of maintaining analgesia was longer than control group(P<0.05).There was no statistically significant difference in total probability of postoperative adverse reactions between two groups(P>0.05).Conclusion During clinical upper limb surgery,dexmedetomidine intravenous anesthesia combined with brachial plexus block can be the first choice,which has good anesthesia quality,low effect on blood pressure and heart rate of patients,and high safety.Therefore,it is worthy of application and promote.