CAJ | 학술논문

目的确定混合罗哌卡因用于腰丛-坐骨神经阻滞时右美托咪定的适宜剂量.方法选择踝关节手术患者80例,ASA分级Ⅰ或Ⅱ级,性别不限,年龄18 ～ 63岁,体重47 ～ 83 kg.采用随机数字表法分为4组(n=20):罗哌卡因组(R组)、不同剂量右美托咪定混合罗哌卡因组(RD1-3组).神经刺激仪引导腰丛-坐骨神经阻滞,采用腰大肌间隙法行腰丛阻滞,R组注射0.5％罗哌卡因20 ml;RD1-3组注射含右美托咪定1.0、1.5和2.0 μg/kg的0.5％罗哌卡因20 ml;采用后路法行坐骨神经阻滞,各组分别注射相应药物10 ml.记录感觉和运动神经阻滞起效时间、持续时间及心血管事件、过度镇静等不良反应的发生情况.结果 4组感觉和运动神经阻滞起效时间差异无统计学意义(P＞0.05).与R组比较,RD1.3组感觉和运动神经阻滞持续时间延长(P＜0.01);与RD1组比较,RD2组和RD3组感觉和运动神经阻滞持续时间延长(P＜0.05);与RD2组比较,RD3组感觉和运动神经阻滞持续时间延长(P＜0.05).RD3组镇静过度、心动过缓发生率较R组和RD1,2组升高(P＜0.05).结论混合罗哌卡因用于腰丛-坐骨神经阻滞时右美托咪定的适宜剂量为1.5 μg/kg.
목적 학정혼합라고잡인용우요총-좌골신경조체시우미탁미정적괄의제량.방법 선택과관절수술환자80례,ASA분급Ⅰ혹Ⅱ급,성별불한,년령18 ～ 63세,체중47 ～ 83 kg.채용수궤수자표법분위4조(n=20):라고잡인조(R조)、불동제량우미탁미정혼합라고잡인조(RD1-3조).신경자격의인도요총-좌골신경조체,채용요대기간극법행요총조체,R조주사0.5％라고잡인20 ml;RD1-3조주사함우미탁미정1.0、1.5화2.0 μg/kg적0.5％라고잡인20 ml;채용후로법행좌골신경조체,각조분별주사상응약물10 ml.기록감각화운동신경조체기효시간、지속시간급심혈관사건、과도진정등불량반응적발생정황.결과 4조감각화운동신경조체기효시간차이무통계학의의(P＞0.05).여R조비교,RD1.3조감각화운동신경조체지속시간연장(P＜0.01);여RD1조비교,RD2조화RD3조감각화운동신경조체지속시간연장(P＜0.05);여RD2조비교,RD3조감각화운동신경조체지속시간연장(P＜0.05).RD3조진정과도、심동과완발생솔교R조화RD1,2조승고(P＜0.05).결론 혼합라고잡인용우요총-좌골신경조체시우미탁미정적괄의제량위1.5 μg/kg.
Objective To determine the optimum dose of dexmedetomidine for lumbar plexus combined with sciatic nerve block when mixed with ropivacaine.Methods Eighty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-63 yr,weighing 47-83 kg,scheduled for elective ankle joint surgery,were randomly divided into 4 groups (n =20 each) using a random number table:ropivacaine group (group R) and different doses of dexmedetomidine mixed with ropivacaine groups (RD1-3 groups).Lumbar plexus block was performed by using psoas-compartment approach guided by a nerve stimulator.0.5％ ropivacaine 20 ml was injected in group R.0.5％ ropivacaine 20 ml containing dexmedetomidine 1.0,1.5 and 2.0 μg/kg was injected in RD1 3 groups,respectively.Labat's sciatic nerve block was performed,and 10 ml of the corresponding drug was injected in each group.The onset time and duration of sensory and motor blockade,and side effects such as cardiovascular events and excessive sedation were recorded.Results There was no significant difference in the onset time and duration of sensory and motor blockade between the four groups.The duration of sensory and motor blockade was significantly longer in RD1-3 groups than in group R,in RD2 and RD3 groups than in group RD1,and in RD3 group than in RD2 group.The incidence of over-sedation and bradycardia was significantly higher in RD3 group than in RD1.2 groups.Conclusion The optimum dose of dexmedetomidine is 1.5 μg/kg for lumbar plexus combined with sciatic nerve block when mixed with ropivacaine.