右美托咪定复合罗哌卡因臂丛神经阻滞对上肢手术患者的镇静镇痛效果

Sedative and analgesic effects of dexmedetomidine combined with ropivacaine brachial plexus block in upper limb surgery

目的分析右美托咪定复合罗哌卡因臂丛神经阻滞对上肢手术患者的镇静、镇痛效果。方法随机对照研究。抽取2022年1月至2022年12月西安市中医医院收治的上肢手术患者120例,按随机数字表法分为对照组和观察组,每组60例。对照组行罗哌卡因臂丛神经阻滞,观察组在对照组基础上加以右美托咪定。比较两组麻醉效果、血流动力学、镇静镇痛效果及不良反应发生率。结果观察组感觉、运动神经阻滞起效时间[(10.41±2.38)、(16.21±2.31)min]短于对照组[(12.79±2.67)、(19.42±3.70)min],维持时间[(649.77±45.63)、(526.89±31.65)min]长于对照组[(503.86±38.97)、(389.77±25.87)min],P<0.05。麻醉后30 min、术毕时,观察组平均动脉压、心率均高于对照组(P均<0.05);术后1、3、6 h,观察组Ramsay镇静评分高于对照组,VAS评分低于对照组(P<0.05)。两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论右美托咪定复合罗哌卡因臂丛神经阻滞可缩短麻醉起效时间,保障上肢手术患者血流动力学稳定,且镇静镇痛效果良好,无严重不良反应。

Objective To analyze the sedative and analgesic effect of dexmedetomidine combined with ropivacaine brachial plexus block on patients undergoing upper limb surgery.Methods A total of 120 patients who experienced upper limb surgery in Xi’an Traditional Chinese Medicine Hospital from January 2022 to December 2022 were selected for the randomized controlled study.And they were divided into control group and observation group by random number table method,with 60 cases in each group.The control group received ropivacaine brachial plexus block,while the observation group received dexmedetomidine based on the regimen of the control group.The anesthesia effect,hemodynamics,sedative and analgesic effects,and adverse reactions were compared between the two groups.Results The onset time of sensory and motor nerve block in the observation group were(10.41±2.38)min and(16.21±2.31)min,respectively,which were shorter than the(12.79±2.67)min and(19.42±3.70)min in the control group(P<0.05).The maintenance time of sensory and motor nerve block in the observation group were(649.77±45.63)min and(526.89±31.65)min,respectively,longer than the(503.86±38.97)min and(389.77±25.87)min in the control group(P<0.05).At 30 minutes after anesthesia and at the end of surgery,the average arterial pressure and heart rate in the observation group were higher than those in the control group(all P<0.05).At 1,3 and 6 hours after surgery,the Ramsay sedation scores in the observation group were higher than those in the control group,and the VAS score in the observation group was lower than that in the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Dexmetomidine combined with ropivacaine brachial plexus block can shorten the onset time of anesthesia,ensure hemodynamic stability in patients undergoing upper limb surgery,and have good sedative and analgesic effects,without severe adverse reactions.