国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2012年
10期
1443-1446
,共4页
张晓欣%朱小兵%刘志群%戚志超%杜燕燕
張曉訢%硃小兵%劉誌群%慼誌超%杜燕燕
장효흔%주소병%류지군%척지초%두연연
右美托咪定%罗哌卡因%臂丛%神经阻滞
右美託咪定%囉哌卡因%臂叢%神經阻滯
우미탁미정%라고잡인%비총%신경조체
Dexmedetomidine%ropivacaine%Brachial plexus%Nerve block
目的 研究盐酸右美托咪定对肌间沟臂丛神经阻滞罗哌卡因血药浓度的影响.方法 拟行肌间沟臂丛神经阻滞的上臂手术患者60例,性别不限,年龄18～59岁,体重46～ 80 kg,ASA分级Ⅰ或Ⅱ级,随机分为两组(n=30);对照组(C组),右美托咪定组(D组).C组神经阻滞用药为0.33％罗哌卡因30 ml,D组用药为右美托咪定100μg+0.33％罗哌卡因混合液30 ml.评价感觉和运动阻滞的效果,记录感觉阻滞和运动阻滞的起效时间和维持时间,于麻醉前(T0)、神经阻滞后1O min(T1)、30 min(手术开始、T2)、60 min(T3)、120min (T6)采静脉血通过高效液相色谱法测定罗哌卡因血药浓度.记录ECG、HR、SPO2、NIBP及恶心呕吐、呼吸抑制、心动过缓等并发症的发生情况.结果 D组T2、T3、T4罗哌卡因浓度分别(2.4±0.12)μ g/ml、(1.784±0.16)μ g/ml 、(1.552±0.12)μ g/ml均高于C组T2、T3、T4时点浓度(1.42±0.15)μg/ml 、(1.36±0.10)μg/ml、(1.02±0.08)μ g/ml(P＜0.05)；C组4例使用芬太尼,1例更改麻醉方式；D组无一例使用芬太尼,无一例更改麻醉方式,4例心动过缓,两组均未见恶心呕吐、呼吸抑制等并发症.与C组比较,D组感觉阻滞、运动阻滞维持时间延长(P＜0.05),起效时间差异无显著性(P＞0.05).结论 右美托咪定可延长罗哌卡因在肌间沟臂丛阻滞的血药浓度,增强其阻滞效果.
目的 研究鹽痠右美託咪定對肌間溝臂叢神經阻滯囉哌卡因血藥濃度的影響.方法 擬行肌間溝臂叢神經阻滯的上臂手術患者60例,性彆不限,年齡18～59歲,體重46～ 80 kg,ASA分級Ⅰ或Ⅱ級,隨機分為兩組(n=30);對照組(C組),右美託咪定組(D組).C組神經阻滯用藥為0.33％囉哌卡因30 ml,D組用藥為右美託咪定100μg+0.33％囉哌卡因混閤液30 ml.評價感覺和運動阻滯的效果,記錄感覺阻滯和運動阻滯的起效時間和維持時間,于痳醉前(T0)、神經阻滯後1O min(T1)、30 min(手術開始、T2)、60 min(T3)、120min (T6)採靜脈血通過高效液相色譜法測定囉哌卡因血藥濃度.記錄ECG、HR、SPO2、NIBP及噁心嘔吐、呼吸抑製、心動過緩等併髮癥的髮生情況.結果 D組T2、T3、T4囉哌卡因濃度分彆(2.4±0.12)μ g/ml、(1.784±0.16)μ g/ml 、(1.552±0.12)μ g/ml均高于C組T2、T3、T4時點濃度(1.42±0.15)μg/ml 、(1.36±0.10)μg/ml、(1.02±0.08)μ g/ml(P＜0.05)；C組4例使用芬太尼,1例更改痳醉方式；D組無一例使用芬太尼,無一例更改痳醉方式,4例心動過緩,兩組均未見噁心嘔吐、呼吸抑製等併髮癥.與C組比較,D組感覺阻滯、運動阻滯維持時間延長(P＜0.05),起效時間差異無顯著性(P＞0.05).結論 右美託咪定可延長囉哌卡因在肌間溝臂叢阻滯的血藥濃度,增彊其阻滯效果.
목적 연구염산우미탁미정대기간구비총신경조체라고잡인혈약농도적영향.방법 의행기간구비총신경조체적상비수술환자60례,성별불한,년령18～59세,체중46～ 80 kg,ASA분급Ⅰ혹Ⅱ급,수궤분위량조(n=30);대조조(C조),우미탁미정조(D조).C조신경조체용약위0.33％라고잡인30 ml,D조용약위우미탁미정100μg+0.33％라고잡인혼합액30 ml.평개감각화운동조체적효과,기록감각조체화운동조체적기효시간화유지시간,우마취전(T0)、신경조체후1O min(T1)、30 min(수술개시、T2)、60 min(T3)、120min (T6)채정맥혈통과고효액상색보법측정라고잡인혈약농도.기록ECG、HR、SPO2、NIBP급악심구토、호흡억제、심동과완등병발증적발생정황.결과 D조T2、T3、T4라고잡인농도분별(2.4±0.12)μ g/ml、(1.784±0.16)μ g/ml 、(1.552±0.12)μ g/ml균고우C조T2、T3、T4시점농도(1.42±0.15)μg/ml 、(1.36±0.10)μg/ml、(1.02±0.08)μ g/ml(P＜0.05)；C조4례사용분태니,1례경개마취방식；D조무일례사용분태니,무일례경개마취방식,4례심동과완,량조균미견악심구토、호흡억제등병발증.여C조비교,D조감각조체、운동조체유지시간연장(P＜0.05),기효시간차이무현저성(P＞0.05).결론 우미탁미정가연장라고잡인재기간구비총조체적혈약농도,증강기조체효과.
Objective To investigate the effect ofdexmedetomidine on interscalene brachial plexus block with ropivacaine in patients undergoing upper extremity surgery.Methods 60 patients ofASA Ⅰ or Ⅱ of both sexes,aged 18 ～ 59 years,weighting 46 ～ 80 kg,scheduled for upper extremity surgery under interscalene brachial plexus block,were randomly divided into 2 groups (n=30 each):control group (group C) and dexmedtomidine group (group D).In group C,interscalene brachial plexus block was performed using 0.33％ ropivacaine 30 ml.In group D,interscalene brachial plexus block was performed with a mixture (30 ml) of 0.33％ ropivacaine and 100 μ g dexmedetomidine.The efficacy of motor and sensoy block was evaluated and the onset time and duration of motor and sensory block were recorded.Venous blood samples were obtained before anesthesia inductiong(T0),and at 10,30,60 and 120 minutes after anesthesia inductiong (T1-4),for determination of plasma concentraions of dexmedetomidine.The complications such as nausea,vomiting,respiratory depression and bradycardia were recorded.Fentanil 3 μ g/kg was given as rescue medication.General anesthesia was used when the operation could not be completed.Results Plasma cortisol concentration was significantly lower at T2,T3,T4in group C than that in group D,in group C,there were four patients needing fentanil for rescue analgesics,and general anesthesia was used in one patient when the operation could not be completed; there was no requrement for rescue analgesics and general anesthesia,bradycardia occured in four patients in group D,no nausea and vomiting,respiratory depression occurred in all patients.The duration of sensory and motor block was significantly longer.Conclusion Dexmedetomidine added to ropivacaine for interscalene brachial plexus block can prolong the duration of the block.
