右美托咪定对超声引导神经阻滞下行下肢手术患者止血带反应的疗效观察

Observation of the effect of dexmedetomidine on tourniquet reaction in patients undergoing lower extremity surgery under ultrasound-guided peripheral nerve block

目的:探讨右美托咪定对超声引导神经阻滞复合腰硬联合麻醉下行下肢手术患者对止血带反应的影响。方法:将行下肢手术的260例患者随机分为对照组和观察组,各130例。所有患者均在超声引导神经阻滞复合腰硬联合麻醉下行下肢手术,研究组额外静脉输注右美托咪定,而对照组则静脉输注等量生理盐水。比较两组上止血前(T_(0))、止血带充气30 min(T_(1))、止血带充气60 min(T_(2))、松开止血带30 min(T_(3))和松开止血带60 min(T_(4))时血流动力学指标、炎症反应和氧化应激反应指标。结果:观察组T_(1)、T_(2)时心率和平均动脉压、T_(1)、T_(2)、T_(3)、T_(4)时肿瘤坏死因子-α水平、T_(4)时白介素-6水平、T_(3)、T_(4)时丙二醛水平均低于对照组,但T_(2)、T_(3)、T_(4)时超氧化物歧化酶水平高于对照组(P<0.05)。结论:超声引导神经阻滞复合腰硬联合麻醉下行下肢手术患者静脉应用右美托咪定可有效抑制止血带反应,从而确保手术顺利实施。

Objective:To investigate the effect of dexmedetomidine on tourniquet reaction in patients undergoing lower extremity surgery under ultrasound-guided peripheral nerve block combined with combined spinal epidural anesthesia.Methods:Two hundred and sixty patients with lower limb surgery were randomly divided into a control group and an observation group with 130 cases each.All patients underwent lower limb surgery under peripheral nerve block combined with combined spinal epidural anesthesia.The observation group was additionally given intravenous infusion of dexmedetomidine,while the control group was given intravenous infusion of equal amount of normal saline instead.The indexes of hemodynamics,inflammatory reaction and oxidative stress reaction were compared between the two groups before hemostasis(T_(0)),30 minutes after tourniquet inflation(T_(1)),60 minutes after tourniquet inflation(T_(2)),30 minutes after tourniquet release(T_(3))and 60 minutes after tourniquet release(T_(4)).Results:Heart rate and mean arterial pressure at T_(1)and T_(2),the levels of tumor necrosis factor-a at T_(1),T_(2),T_(3)and T_(4),the levels of interleukin 6 at T_(4)and the levels of malondialdehyde at T_(3)and T_(4)were all lower in the observation group than control group,however,the levels of superoxide dismutase at T_(2),T_(3)and T_(4)were higher in the observation group than the control group(P<0.05).Conclusion:Intravenous dexmedetomidine can effectively inhibit tourniquet reaction in patients underg procedure.