首页
期刊简介
编 委 会
期刊订阅
百年学会 医星璀璨
名院风范
学科风华
菁英风采
投稿须知
过刊浏览
联系我们
篇名
关键词
作者
作者单位
摘要
关键词
注册本刊作者
作者投稿查稿
专家远程审稿
编辑在线审稿
编务办公专区
主编办公专区
下载文档
《上海医学》审稿费代缴委托书
《上海医学》杂志2024年征订启事回执
《上海医学》期刊编审系统审稿专家使用手册
工作动态
03-05
《上海医学》杂志2024年度“春蕾杯”论文评比征文通知
06-14
创新驱动,培育人才—《上海医学》2021年度春蕾计划评审结果揭晓
01-21
《上海医学》期刊影响力指标和学科排名取得显著提升
01-20
《上海医学》恭祝大家新年快乐!
08-18
作废声明
联系方式
发行周期:
月刊
主管单位:
上海市卫生健康委员会
主办单位:
上海市医学会
编辑出版:
《上海医学》编辑部
联系地址:
上海市北京西路1623号
邮编:
200040
电话:
021-62178606
传真:
021-62178606
邮箱:
smasmj@shsma.org.cn
ISSN:
ISSN0253-9934
CN:
CN31-1366/R
收款账号:
1001255309008900719
账户名:
上海市医学会
开户行:
工商银行上海市静安寺支行
友情链接
上海市医学会
当前位置:首页 >
右美托咪定辅助下肢神经阻滞在骨科手术中的应用
Application of dexmedetomidine combined with lower extremity nerve block in orthopaedic surgery
浏览(527) 下载(0)
DOI:
作者:
张清福,曹俊,江伟,葛东明
ZHANG Qingfu ,CAO Jun,JIANG Wei,GE Dongming
作者单位:
上海交通大学附属第六人民医院
Department of Anesthesiology , Affiliated Sixth People,s Hospital , Shanghai Jiao tong University
关键词:
关键词:右美托咪定; B超;下肢神经阻滞;骨科手术
Dexmedetomidine ; Ultrasound; Lower extremity nerve block; Orthpaedic surgery
摘要:
目的:观察右美托咪定辅助下肢神经阻滞在骨科手术中的安全性与有效性。方法:选取拟行下肢膝关节及以下手术的患者40例,随机分为D组和C组;D组在B超引导下实施股神经和坐骨神经阻滞,后经静脉给予右旋美托咪定(DEX)负荷剂量1ug/Kg(稀释至20ml微泵输注20分钟),术中给予DEX维持量0.2ug.Kg-1h-1;C组,实施神经阻滞后给予20ml生理盐水(微泵输注20分钟)。所有患者均使用了自动气压止血带,压力设置为70kpa,如果出现止血带不耐受给予芬太尼100ug。观察两组患者在神经阻滞前T0,神经阻滞后T1,手术开始即刻T2,手术开始后15minT3,手术开始后30minTT4,手术开始后45minT5的MAP,SPO2,HR,RR,并进行Ramsay镇静评分,记录止血带不能耐受时间和出血量。结果:D组仅有3例加芬太尼,C组11例加用芬太尼。D组中,在T2~T5与T0比较HR与RR均明显减慢(P<0.05);C组中在T2~T5与T0比较MAP明显升高。D组与C组比较,在T2~T5,HR与RR有显著差异(P<0.05),D组在T3~T5时Ramsay 评分较C组明显升高(P<0.05)。D组止血带耐受时较C组明显延长(P<0.05)。两组出血量无显著差异。结论: 右美托咪定可为神经阻滞下进行下肢手术的患者提供良好的镇静,减少芬太尼的使用,延长止血带耐受时间。
Objective To investigate the safety and effectiveness of dexmedetomidine(DEX) combined with lower extremity nerve block in Orthopaedic surgery below the knee joint. Methods A total of 40 people were divided randomly into two groups: group D(Femoral nerve sciatic nerve block combined with DEX) and group C(Femoral nerve sciatic nerve block combined with placebo).All the patients receive nerve block under ultrasound guide,and then the patients in group D received a loading dose of DEX 1ug*kg-1 (With physiological saline dilution to 20 ml)for 20 minutes and the continues infusion of 0.2ug.kg.-1h-1 until the end of surgery . The patients in group C received same regime of 20ml physiological saline as control.Medical tourniquet with pressure of 70 kpa was used to reduce bleeding.A dose of fentanyl 100ug was added to those who could not tolerate the tourniquet pain. The changes of MAP ,SPO2 ,HR ,RR and Ramsay scores were recorded before(T0) and after(T1) anesthesia ; at the beginning of surgery(T2) ,and 15min(T3),30min(T4),45min(T5) during the surgery. The tourniquet intolerance time and blood loss was recorded, as well as adverse reaction. Results The number of patients needed fentanyl in group D was less than that in group C(3 vs 11 respectively).During operation time (T2-T5),HR and RR in group D decreased significantly(P<0.05 vs T0) and were lower than those in group C.MAP in group C increased in the mean time significantly. When compared to TO and was higher than those in group D. During the time T3 and T5, the Ramsay scores in group D were statistically higher than those in group C(P<0.05) .The tourniquet tolerance time is longer in group D than that in group C(P<0.05). Conclusion In Orthopaedic surgery below the knee joint with lower extremity nerve block anesthesia, DEX has safe sedative effect by extending the tourniquet tolerance time ,and reducing the use of fentanyl.
点击下载DOC全文