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右美托咪定辅助超声联合神经刺激仪引导神经阻滞在老年膝关节镜手术中应用的观察
Application of dexmedetomidine assisted nerve blocks guided by ultrasound joint nerve stimulator on elderly patients undergoing knee arthroscopy
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DOI:
作者:
高涛;邓迎丰;刘慧松;涂灿;魏鹏;尹峰
Gao Tao, Deng Yingfeng, Liu Huisong, Tu Can,Wei Pen,Yin Feng
作者单位:
同济大学医学院附属东方医院(现在宁波大学医学院附属医院麻醉科工作)
Department of Surgery, Dongfang Hospital, the Affiliated Hospital of Tongji University
关键词:
右美托咪定;神经传导阻滞;老年人;膝关节镜
Dexmedetomidine; Nerve blocks; Elderly; Knee arthroscopy
摘要:
目的 探讨右美托咪定辅助超声联合神经刺激仪引导神经阻滞在老年膝关节镜手术中的安全性和有效性。方法 择期行单侧膝关节镜手术的老年患者100例,美国麻醉医师学会(ASA)分级Ⅱ~Ⅲ级,采用随机数字表法分为2组,各50例,神经阻滞组(N组)和右美托咪定辅助神经阻滞组(D组)。D组于神经阻滞前静脉泵注右美托咪定,负荷剂量0.5μg/kg用0.9%氯化钠溶液稀释到20ml在10min内泵完,并以0.2μg•kg-1•h-1持续泵注至手术结束前30min;N组以同样方法泵注等容量0.9%氯化钠溶液。负荷剂量输注完毕后,两组分别在超声联合神经刺激仪引导下完成连续股神经复合股外侧皮神经阻滞。分别记录负荷量泵注前(T0)、负荷量泵注结束(T1)、麻醉结束(T2)、手术开始即刻(T3)、手术开始后15min(T4)、手术开始后30min(T5)和手术结束时(T6)的MAP、HR和SpO2;以及术中丙泊酚和芬太尼的使用及不良反应的发生情况。 结果 与T0时比较,N组患者MAP在T2~T4时明显升高,差异有统计学意义(均P<0.05);与D组比较,N组患者MAP在T2~T6时明显升高,且术中发生呼吸抑制和高血压的例数及使用丙泊酚和芬太尼的例数明显增高,差异有统计学意义(均P<0.05)。 结论 右美托咪定辅助超声联合神经刺激仪引导神经阻滞应用于老年膝关节镜手术能使患者术中循环呼吸稳定、麻醉管理简便,且不良反应少,值得在临床推广应用。
Objective To investigate the effect and safety of dexmedetomidine assisted nerve blocks guided by ultrasound joint nerve stimulator on elderly patients undergoing knee arthroscopy. Methods One hundred ASA Ⅱ or Ⅲ elderly patients, undergoing unilateral knee arthroscopy were randomly allocated to two groups (n=50): patients in group N received continuous femoral nerve block combined with lateral femoral cutaneous nerve block and in group D received dexmedetomidine assisted the same nerve blocks. For Group D, a loading dose of dexmedetomidine 0.5μg/kg, diluted into 20 ml normal saline, was infused within 10 minutes before nerve blocks and received the same infusion with a constant speed of 0.2μg•kg-1•h-1 untill 30 minutes before the end of surgery; Group N received the infusion of normal saline in the same way. After the loading dose infusion, the nerve blocks were performed guided by ultrasound joint nerve stimulator in both groups. The mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at each time point as follows: start (T0) and the end (T1) of the loading dose infusion, nerve blocks ends (T2), at 0 (T3), 15 (T4) and 30 (T5) min after incision, and at the end of surgery (T6); side effects, requirement for propofol and fentanyl were also recorded. Results In group N, MAP at T2~T4 was remarkably elevated (P<0.05), comparing with the baseline value at T0. Compared with group D, MAP at T2~T6 was significantly increased in group N (P<0.05); and the incidences of respiratory depression and hypertension, requirements for propofol and fentanyl were significantly increased in group N (P<0.05). Conclusion Dexmedetomidine can increase the efficacy of nerve blocks guided by ultrasound joint nerve stimulator when used for knee arthroscopy in the elderly patients, which showed stable hemodynamic performance, simple anesthesia management and fewer side effects incidences.
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