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罗哌卡因复合右美托咪定对腋路臂丛神经阻滞的影响
The effect of dexmedetomidine combined with ropivacaine for ultrasound-guided axillary brachial plexus block
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DOI:
作者:
金耀君,赵璇
JIN Yaojun,ZHAO Xuan
作者单位:
上海交通大学医学院附属新华医院
Department of Anesthsiology,Xinhua Hospital,Shanghai Jiaotong University School of Medicine
关键词:
右美托咪定;腋路臂丛神经阻滞;超声
Dexmedetomidine;Axillary Brachial Plexus Block;Ultrasound
摘要:
目的 研究罗哌卡因复合右美托咪定用于超声引导下腋路臂丛神经阻滞的有效性及安全性。方法 择期行前臂或手部手术的患者120例,随机分为4组,在超声引导下行腋路臂丛神经阻滞,分别给予单纯0.5%罗哌卡因(N组),0.5%罗哌卡因局部复合50µg右美托咪定(L50组),0.5%罗哌卡因局部复合100µg右美托咪定(L100组)和0.5%罗哌卡因静脉复合50µg右美托咪定(V50组),记录各组患者感觉与运动阻滞起效时间,运动阻滞时间,镇痛持续时间以及患者麻醉前(T0)及麻醉后15min(T1),30min(T2),45min(T3),60min(T4)的心率(HR)和平均动脉压(MAP)。结果 L50组和L100组较N组和V50组感觉及运动阻滞起效时间均缩短,运动阻滞时间和镇痛持续时间均延长(P<0.05),但两组之间差异无统计学意义;L100组在T2,T3,T4时间点和V50组在T3,T4时间点的心率及血压较N组和L50组显著性降低(P<0.05),L50组与N组各个时间点的心率和血压的差异无统计学意义。结论 超声引导下行腋路臂丛神经阻滞时,罗哌卡因局部复合50ug右美托咪定可以缩短感觉及运动阻滞起效时间,并延长运动阻滞时间和镇痛持续时间,而且对血压和心率的影响小。
Objective To evaluate the efficacy and safety of dexmedetomidine combined with ropivacaine for ultrasound-guided axillary brachial plexus block.Methods A total of 120 patients scheduled for elective forearm and hand surgery were randomly divided into 4 groups.Ultrasound-guided axillary brachial plexus block was performed with either 28mL of ropivacaine 0.5% alone(group N),28mL of ropivacaine 0.5% combined with 50µg dexmedetomidine locally((group L50), 28mL of ropivacaine 0.5% combined with 100µg dexmedetomidine locally(group L100)or 28mL of ropivacaine 0.5% combined with 50µg dexmedetomidine intravenously(group V50).Sensory and motor block onset times, motor block and analgesia durations were recorded.Heart rate(HR)and mean arterial pressure(MAP) at some critical time points,namely,before anesthsia(T0)and 15 minutes(T1),30 minutes(T2),45 minutes(T3),60 minutes(T4) after anesthsia were recorded as well.Results Compared with group N and group V50,sensory and motor block onset times were significantly shorter and motor block and analgesia durations were significantly longer in group L50 and L100 (P<0.05).There was no significant difference between the two groups.HR and MAP at T2,T3,T4 in group L100 were significantly lower than those in group N and group L50 (P<0.05).HR and MAP at T3,T4 in group V50 were significantly lower than those in group N and group L50 (P<0.05).There was no significant difference at any time point between group N and group L50.Conclusion Ropivacaine combined with 50µg dexmedetomidine locally for ultrasound-guided axillary brachial plexus block shortened sensory and motor block onset times,prolonged motor block and analgesia durations,and had little effect on heart rate and blood pressure.
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