CAJ | 학술논문

目的探讨右美托咪啶对超声引导下臂丛神经阻滞术中及术后镇痛效果的影响.方法选取60例择期行单侧手或前臂手术的患者,均接受超声引导下臂丛神经阻滞.将患者按随机数字表法分为研究组和对照组,每组30例.研究组患者使用0.5％罗哌卡因100 mg和0.75μg/kg右美托咪啶合剂,对照组患者使用0.5％罗哌卡因100 mg.记录入手术室时、臂丛神经阻滞后、切皮时、手术结束患者心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2).臂丛神经阻滞成功后,记录切皮时、手术1h及术后1,2,6,12,24和48 h视觉模拟评分(VAS).当VAS超过4分时给予吗啡治疗,并记录术后首次使用吗啡时间及术后48 h吗啡用量.记录不良反应.结果两组入手术室时和臂丛神经阻滞后心率、MAP比较差异无统计学意义(P＞0.05),研究组切皮时和手术结束心率、MAP明显低于入手术室时和同期对照组,差异有统计学意义(P＜0.05).两组各时间点SpO2比较差异无统计学意义(P＞0.05).研究组术后6,12,24和48 h VAS均低于对照组[(3.0±0.9)分比(4.9±0.5)分、(3.0±0.7)分比(5.6±1.2)分、(2.2±0.9)分比(4.8±1.8)分、(1.7±0.5)分比(3.2±1.0)分],差异有统计学意义(P＜0.05).研究组术后首次使用吗啡时间明显长于对照组[(450±37) min比(368±42)min],术后48 h吗啡用量明显少于对照组[(8.3±2.8)mg比(15.5±4.5) mg],差异有统计学意义(P＜0.05).两组患者均未发生明显不良反应.结论超声引导下臂丛神经阻滞时罗哌卡因复合应用0.75μg/kg右美托咪啶可显著延长镇痛时间,减少术后48 h吗啡用量,而且未发生显著的不良反应.
목적 탐토우미탁미정대초성인도하비총신경조체술중급술후진통효과적영향.방법 선취60례택기행단측수혹전비수술적환자,균접수초성인도하비총신경조체.장환자안수궤수자표법분위연구조화대조조,매조30례.연구조환자사용0.5％라고잡인100 mg화0.75μg/kg우미탁미정합제,대조조환자사용0.5％라고잡인100 mg.기록입수술실시、비총신경조체후、절피시、수술결속환자심솔、평균동맥압(MAP)、맥박혈양포화도(SpO2).비총신경조체성공후,기록절피시、수술1h급술후1,2,6,12,24화48 h시각모의평분(VAS).당VAS초과4분시급여마배치료,병기록술후수차사용마배시간급술후48 h마배용량.기록불량반응.결과 량조입수술실시화비총신경조체후심솔、MAP비교차이무통계학의의(P＞0.05),연구조절피시화수술결속심솔、MAP명현저우입수술실시화동기대조조,차이유통계학의의(P＜0.05).량조각시간점SpO2비교차이무통계학의의(P＞0.05).연구조술후6,12,24화48 h VAS균저우대조조[(3.0±0.9)분비(4.9±0.5)분、(3.0±0.7)분비(5.6±1.2)분、(2.2±0.9)분비(4.8±1.8)분、(1.7±0.5)분비(3.2±1.0)분],차이유통계학의의(P＜0.05).연구조술후수차사용마배시간명현장우대조조[(450±37) min비(368±42)min],술후48 h마배용량명현소우대조조[(8.3±2.8)mg비(15.5±4.5) mg],차이유통계학의의(P＜0.05).량조환자균미발생명현불량반응.결론 초성인도하비총신경조체시라고잡인복합응용0.75μg/kg우미탁미정가현저연장진통시간,감소술후48 h마배용량,이차미발생현저적불량반응.
Objective To evaluate the analgesic effect of dexmedetomidine on the ultrasonic guidance brachial plexus block.Methods Sixty patients who underwent elective for one-side upper limb or forearm surgery were selected,they were received ultrasonic guidance brachial plexus block.The patients were divided into observation group and control group by random digits table method with 30 cases each.The observation group received 0.5％ ropivacaine 100 mg and dexmedetomidine 0.75 μg/kg,and the control group received 0.5％ ropivacaine 100 mg alone.The heart rate,mean arterial pressure (MAP),pulse oxygen saturation (SpO2) at the time of entering operating room,brachial plexus block completed,incision and the end of surgery were recorded.After brachial plexus block completed,the visual analogue score (VAS) at the time of incision,1 h during surgery and 1,2,6,12,24,48 h after surgery was recorded.Morphine was given the patients when VAS ＞ 4 scores,and the time to first prescription of morphine and total morphine consumption dose within 48 h after surgery were also detected.The adverse reaction was recorded.Results There were no statistical differences in heart rate and MAP at the time of entering operating room and brachial plexus block completed between the 2 groups (P ＞ 0.05).The heart rate and MAP at the time of incision and the end of surgery in observation group were significantly lower than those at the time of entering operating and the same time of control group,there were statistical differences (P ＜ 0.05).There was no statistical difference in SpO2 between the 2 groups (P ＞0.05).The VAS at the time of 6,12,24 and 48 h after surgery in observation group were significantly lower than those in control group [(3.0 ± 0.9) scores vs.(4.9 ± 0.5) scores,(3.0 ± 0.7) scores vs.(5.6 ± 1.2) scores,(2.2 ± 0.9) scores vs.(4.8 ± 1.8) scores,(1.7 ± 0.5) scores vs.(3.2 ± 1.0) scores],there were statistical differences (P ＜ 0.05).The time to first prescription of morphine in observation group was significantly longer than that in control group [(450 ± 37) min vs.(368 ± 42) min],the total morphine consumption dose was significantly lower than that in control group [(8.3 ± 2.8) mg vs.(15.5 ± 4.5) mg],there were statistical differences (P ＜ 0.05).There was no adverse reaction found.Conclusion Ropivacaine plus 0.75 μ g/kg dexmedetomidine for ultrasonic guidance brachial plexus block may prolong the duration of analgesia,thus reduce morphine consumption within 48 h after surgery without severe adverse reaction.