右美托咪定联合臂丛神经阻滞麻醉用于老年高血压骨科手术的观察

Application of dexmedetomidine combined with brachial plexus block anesthesia in orthopedic surgery for senile patients with hypertension

目的观察右美托咪定在高血压老年患者臂丛神经阻滞麻醉下的应用。方法选择2016年1月—2017年8月马鞍山市中心医院收治的择期行上肢和肩部手术的高血压老年患者60例作为研究对象,随机分为观察组(A组)和对照组(B组)两组,每组各30例。A组先给予右美托咪定负荷量(浓度为4μg/ml) 0.5μg/kg,然后以3μg/(kg·h)持续至患者达到Ramsay 3级镇静;然后在B超定位下进行肌间沟入路臂丛神经阻滞,将2%利多卡因10 ml+0.75%罗哌卡因10 ml注射进去。对照组在B超定位下进行肌间沟入路臂丛神经阻滞,同样注入2%利多卡因10 ml+0.75%罗哌卡因10 ml。A组再以右美托咪定0.2μg/(kg·h)维持至手术结束。B组以等量生理盐水到手术结束,分别记录T0(入室)、T1(臂丛穿刺时)、T2(手术开始10 min) T3(手术开始30 min)、T4(手术结束时)的HR、MAP、SPO2、VAS评分、Ramsay评分和术后24 h遗忘性分析。结果与B组比较,A组患者T1~T4时HR明显减慢,MAP明显降低(P<0.05); A组患者T1~T4的VAS评分明显降低(P<0.05),Ramsay评分明显增加(P<0.05)。A组术后访视发现患者对麻醉穿刺和对手术不良刺激的遗忘性高(P<0.05)。结论右美托咪定具有一定的降压和顺行性遗忘作用,可安全有效地应用于臂丛神经阻滞下上肢手术的辅助镇静镇痛。

Objective To observe the application of dexmedetomidine in brachial plexus block anesthesia for elderly hypertensive patients.Methods Sixty patients those who will receive upper extremity and shoulder surgeries during January 2016 and August 2018 were randomly divided into observation group(group A)and control group(group B),30 cases in each group.Group A was given dexmedetomidine(4μg/ml)at the dose of 0.5μg/kg,then the dose just to 3μg/(kg·h)until the patient reached Ramsay level 3 sedation.B-plexus approach was then performed with B-mode ultrasonography,10 ml of 2%lidocaine and 10 ml of 0.75%ropivacaine were injected into the group A,and then maintained injection of dexmedetomidine at the dose of 0.2μg/(kg·h)until the end of surgery.Brachial plexus block in group B also guided by B-mode ultrasonography,10 ml of 2%lidocaine and 10 ml of 0.75%ropivacaine were injected,and then,the same amount of normal saline was given patients in group B until the end of surgery.The HR,MAP,Sp O2,VAS score and Ramsay score at the time points T0(the patients entered the operation room),T1(at the time of brachial plexus puncture),T2(10 min after the start of surgery),T3(30 min after the start of surgery)and T4(at the end of surgery)and 24 h postoperative amnesia were analyzed.Results Compared with group B,the HR of group A was significantly slow down and the MAP was significantly decreased at the time points T1 to T4(P<0.05).The VAS score of group T1 was significantly decreased(P<0.05)and Ramsay score was significantly increased(P<0.05).Postoperative visits found that patients performed high amnesia in narcotic puncture and harmful surgical stimulation(P<0.05).Conclusions Dexmedetomidine has certain antihypertensive and amnesic oblivion effect,which could be safely and effectively applied to the auxiliary sedation and analgesia of upper limb surgery under brachial plexus block.