CAJ | 학술논문

目的观察右美托咪定(dexmedetomidine,DEX)在臂丛神经阻滞不全时的辅助强化麻醉效果及安全性评价.方法将臂丛神经阻滞麻醉后出现阻滞不全的手外伤择期手术患者42例以完全随机分组法随机分为A组(杜氟合剂强化麻醉组)和B组(DEX强化麻醉组),每组21例.A组给予杜氟合剂(盐酸哌替啶25 mg+氟哌利多2.5 mg),B组给予DEX,DEX以2ml(200μg)加入48 ml生理盐水中,以0.8 μg/kg的剂量以微量泵10 min内缓慢静脉注射给予负荷量,继以0.4 μg·kg-1·h-1持续泵入至手术前10 min停用.于强化麻醉前(T0)、强化麻醉后5(T1)、10(T2)、30 min(T3),术毕(T4)记录收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)及经皮血氧饱和度(transcutaneous oxygen saturation,SpO2)、疼痛视觉模拟评分(visual analogue scale,VAS)、Ramsay评分及相关副作用. 结果 B组于T1、T2、T4 3个时间点VAS评分低于A组[0(3.5) vs 3.5(3),0(1)vs 2(2.75),0(1) vs 2.5(3)] (P＜0.05);T1～T4时间点的Ramsay评分B组高于A组[(2.8±0.9)vs(1.8±0.9),(3.9±0.3)vs(2.8±0.9),(3.7±0.7)vs(2.7±0.9),(2.3±0.6)vs(1.3±0.8)](P＜0.01)；两组低血压、窦性心动过缓、恶心呕吐的副作用发生率比较差异无统计学意义(P＞0.05)；两组组内各时间点SBP、DBP、HR变化有统计学意义(P＜0.01)；组内各时间点SpO2比较差异无统计学意义(P＞0.05)；两组间各指标各时间点比较差异无统计学意义(P＞0.05). 结论静脉泵注DEX具有较好的镇静、镇痛效果,安全性高,可作为臂丛麻醉阻滞不全时的强化麻醉药物选择.
목적 관찰우미탁미정(dexmedetomidine,DEX)재비총신경조체불전시적보조강화마취효과급안전성평개.방법 장비총신경조체마취후출현조체불전적수외상택기수술환자42례이완전수궤분조법수궤분위A조(두불합제강화마취조)화B조(DEX강화마취조),매조21례.A조급여두불합제(염산고체정25 mg+불고리다2.5 mg),B조급여DEX,DEX이2ml(200μg)가입48 ml생리염수중,이0.8 μg/kg적제량이미량빙10 min내완만정맥주사급여부하량,계이0.4 μg·kg-1·h-1지속빙입지수술전10 min정용.우강화마취전(T0)、강화마취후5(T1)、10(T2)、30 min(T3),술필(T4)기록수축압(systolic blood pressure,SBP)、서장압(diastolic blood pressure,DBP)、심솔(heart rate,HR)급경피혈양포화도(transcutaneous oxygen saturation,SpO2)、동통시각모의평분(visual analogue scale,VAS)、Ramsay평분급상관부작용. 결과 B조우T1、T2、T4 3개시간점VAS평분저우A조[0(3.5) vs 3.5(3),0(1)vs 2(2.75),0(1) vs 2.5(3)] (P＜0.05);T1～T4시간점적Ramsay평분B조고우A조[(2.8±0.9)vs(1.8±0.9),(3.9±0.3)vs(2.8±0.9),(3.7±0.7)vs(2.7±0.9),(2.3±0.6)vs(1.3±0.8)](P＜0.01)；량조저혈압、두성심동과완、악심구토적부작용발생솔비교차이무통계학의의(P＞0.05)；량조조내각시간점SBP、DBP、HR변화유통계학의의(P＜0.01)；조내각시간점SpO2비교차이무통계학의의(P＞0.05)；량조간각지표각시간점비교차이무통계학의의(P＞0.05). 결론 정맥빙주DEX구유교호적진정、진통효과,안전성고,가작위비총마취조체불전시적강화마취약물선택.
Objective To evaluate the effect of potentiated anesthesia of dexmedetomidine (DEX) when brachial plexus block were unsuccessful.Methods 42 patients with incomplete brachial plexus block were randomly divided into 2 groups(group A and group B,n=21).Sauteralgyl 25 mg and droperidol 2.5 mg were used in group A,0.8 μg/kg of DEX were used in group B within 10 min as a bolus,and 0.4 μg ·kg-1 ·h-1 of DEX were infused continuously until the end of the operation.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),transcutaneous oxygen saturation (SpO2),visual analogue scale (VAS),Ramsay score and other side effects were recorded before potentiated anesthesia (T0) and 5(T1),10(T2),30 min (T3) after potentiated anesthesia and end of operation(T4).Results Compared with group A,VAS were lower in group B[0(3.5) vs 3.5(3),0(1)vs 2(2.75),0(1) vs 2.5(3) at T1,T2,T4,respectively,P＜0.05].The Ramsay score in group B were higher than that of group A [(2.8±0.9) vs (1.8±0.9),(3.9±0.3) vs (2.8±0.9),(3.7±0.7) vs (2.7±0.9),(2.3±0.6) vs (1.3±0.8) at T1,T2,T3,T4,respectively,P＜0.01].There were no significant difference between two groups in other side effects such as hypotension,sinus bradycardia,nausea and vomiting(P＞0.05).There were no significant difference between two groups at each time point in SBP,DBP,HR and SpO2(P＞ 0.05),although there were significant difference among each group in SBP,DBP,HR(P＜0.01).Conclusions DEX can be used to strengthen the effect of brachial plexus block,with good analgesia and sedation,and high safety.