CAJ | 학술논문

目的探讨右美托咪啶对上肢手术患者臂丛神经阻滞及上肢缺血再灌注损伤的影响.方法拟行腋路臂丛神经阻滞的上肢手术患者40例,性别不限,年龄18～55岁,体重45～80kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为2组(n=20),对照组(C组):神经阻滞用药为0.5%罗哌卡因30 ml;右美托咪啶组(D组):神经阻滞用药为0.5%罗哌卡因+右美托咪啶8 mg混合液30 ml.评价感觉阻滞和运动阻滞的效果,记录感觉阻滞和运动阻滞的起效时间和维持时间,于麻醉诱导前(T0)、松止血带后1、5和30 min(T1-3)时抽取术侧肘部静脉血样,测定血浆MDA和缺血修饰蛋白(IMA)的浓度,同时取术侧肘部动脉血样,行血气分析.记录术中恶心呕吐、呼吸抑制、头晕、心动过缓等并发症的发生情况.术中主诉疼痛的患者静脉注射舒芬太尼0.2μg/kg,仍因疼痛无法完成手术的患者则改为全身麻醉.结果无一例患者使用补救用药,无一例患者更改麻醉方式,所有患者均未发生恶心呕吐、呼吸抑制、头晕、心动过缓等并发症.与C组比较,D组感觉阻滞、运动阻滞维持时间明显延长,血浆MDA和IMA的浓度明显降低,PaO2和BE升高(P＜0.05),感觉阻滞和运动阻滞的起效时间差异无统计学意义(P＞0.05);与T0时比较,两组T2、T3时血浆MDA和IMA的浓度升高,C组T1时pH值降低,两组T1时PaO2降低,T1、T2时BE降低(P＜0.05).结论右美托咪啶不仅可增强上肢手术患者罗哌卡因臂丛神经阻滞效果,还可减轻止血带诱发的上肢缺血再灌注损伤.
목적 탐토우미탁미정대상지수술환자비총신경조체급상지결혈재관주손상적영향.방법 의행액로비총신경조체적상지수술환자40례,성별불한,년령18～55세,체중45～80kg,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장환자수궤분위2조(n=20),대조조(C조):신경조체용약위0.5%라고잡인30 ml;우미탁미정조(D조):신경조체용약위0.5%라고잡인+우미탁미정8 mg혼합액30 ml.평개감각조체화운동조체적효과,기록감각조체화운동조체적기효시간화유지시간,우마취유도전(T0)、송지혈대후1、5화30 min(T1-3)시추취술측주부정맥혈양,측정혈장MDA화결혈수식단백(IMA)적농도,동시취술측주부동맥혈양,행혈기분석.기록술중악심구토、호흡억제、두훈、심동과완등병발증적발생정황.술중주소동통적환자정맥주사서분태니0.2μg/kg,잉인동통무법완성수술적환자칙개위전신마취.결과 무일례환자사용보구용약,무일례환자경개마취방식,소유환자균미발생악심구토、호흡억제、두훈、심동과완등병발증.여C조비교,D조감각조체、운동조체유지시간명현연장,혈장MDA화IMA적농도명현강저,PaO2화BE승고(P＜0.05),감각조체화운동조체적기효시간차이무통계학의의(P＞0.05);여T0시비교,량조T2、T3시혈장MDA화IMA적농도승고,C조T1시pH치강저,량조T1시PaO2강저,T1、T2시BE강저(P＜0.05).결론 우미탁미정불부가증강상지수술환자라고잡인비총신경조체효과,환가감경지혈대유발적상지결혈재관주손상.
Objective To investigate the effect of dexmedetomidine on brachial plexus block with ropivacaine and upper extremity ischemia-reperfusion (I/R) injury in patients undergoing upper extremity surgery. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes, aged 18-55 yr, weighing 45-80 kg, scheduled forupper extremity surgery under brachial plexus block, were randomly divided into 2 groups ( n = 20 each): control group ( group C )and dexmedtomidine group (group D). In group C, brachial plexus block was performed using 0.5% ropivacaine 30 ml. In group D, brachial plexus block was performed with a mixture (30 ml) of 0.5% ropivacaine and 8 mg dexmedetomidine. The efficacy of motor and sensory block was evaluated and the onset time and duration of motor and sensory block were recorded. Venous blood samples were obtained from peripheral vein on the operated side before anesthesia induction (T0), and at 1, 5 and 30 min after tourniquet release (T1-3) to detect the plasma concentrations of MDA and ischemia-modified albumi (IMA). Arterial blood samples were also obtained at the same time points for blood gas analysis. The complications such as nausea and vomiting, respiratory depression, bradycardia and dizziness were recorded. Sufentanil 0.2 μg/kg was given as rescue medication. If the operation could not be completed, general anesthesia was used. Results There was no requirement for rescue analgesics and general anesthesia, and no complications occurred in all the patients. The duration of sensory and motor block was significantly longer, the plasma concentrations of MDA and IMA were significantly lower, and PaO2 and BE were significantly higher in group D than in group C ( P ＜ 0.05). The plasma concentrations of MDA and IMA were significantly higher at T2 and T3 in both groups, the pH value was significantly lower at T1 in group C, PaO2 at T1 and BE at T1 and T2 were significantly lower in both groups than those at T0 ( P ＜ 0.05). Conclusion Dexmedetomidine can not only enhance the efficacy of brachial plexus block with ropivacaine, but also reduce the upper extremity I/R injury caused by tourniquet in patients undergoing upper extremity surgery.