CAJ | 학술논문

目的：观察不同剂量右美托咪啶复合罗哌卡因行臂丛神经阻滞及缓解止血带疼痛程度的影响。方法选择60例ASA I~Ⅱ级择期行臂丛神经阻滞的患者，年龄18~65岁，随机分为3组（各20例）：罗哌卡因组（R组）、不同剂量右美托咪定混合罗哌卡因组（RD1-2组）， R组单次注射0.5％罗哌卡因35ml；RD1-2组单次注射含右美托咪定[0.75μg/kg（RD1组）、1.25μg/kg（RD2组）]的0.5％罗哌卡因35ml。记录两组阻滞起效、持续时间，并于止血带压迫120min（Ta）时以VAS评分法评估患者止血带压迫疼痛程度。以Ramsay评分评价患者各时间点RD1-2组镇静程度并记录不良反应。结果与R组比较，RD1-2组阻滞起效时间缩短，持续时间延长（P<0.05），Ramsay评分升高（P<0.05），Ta时点止血带压迫疼痛减轻（P<0.05），与RD1组比较，RD2组阻滞起效、持续时间差异无统计学意义（P>0.05），而RD2组T1-3时间点Ramsay评分升高（P<0.05），Ta时点止血带疼痛程度程度减轻（P<0.05）。RD2组少数患者出现心动过缓和镇静过度，其余各组未见不良反应。结论右美托咪定0.75ug/kg混合0.5％罗哌卡因35m1可安全、有效地用于腋路臂丛神经阻滞，并可有效缓解止血带压迫疼痛程度。
목적：관찰불동제량우미탁미정복합라고잡인행비총신경조체급완해지혈대동통정도적영향。방법선택60례ASA I~Ⅱ급택기행비총신경조체적환자，년령18~65세，수궤분위3조（각20례）：라고잡인조（R조）、불동제량우미탁미정혼합라고잡인조（RD1-2조）， R조단차주사0.5％라고잡인35ml；RD1-2조단차주사함우미탁미정[0.75μg/kg（RD1조）、1.25μg/kg（RD2조）]적0.5％라고잡인35ml。기록량조조체기효、지속시간，병우지혈대압박120min（Ta）시이VAS평분법평고환자지혈대압박동통정도。이Ramsay평분평개환자각시간점RD1-2조진정정도병기록불량반응。결과여R조비교，RD1-2조조체기효시간축단，지속시간연장（P<0.05），Ramsay평분승고（P<0.05），Ta시점지혈대압박동통감경（P<0.05），여RD1조비교，RD2조조체기효、지속시간차이무통계학의의（P>0.05），이RD2조T1-3시간점Ramsay평분승고（P<0.05），Ta시점지혈대동통정도정도감경（P<0.05）。RD2조소수환자출현심동과완화진정과도，기여각조미견불량반응。결론우미탁미정0.75ug/kg혼합0.5％라고잡인35m1가안전、유효지용우액로비총신경조체，병가유효완해지혈대압박동통정도。
Objective To evaluate the efficacy of different doses of dexmedetomidine mixed with ropivacaine for brachial plexus block and the efficacy of alleviating the tourniquet pain.Methods Sixty ASA physical status I orⅡpatients aged 18-65 yr were randomly divided into 3 groups(n=20 each):ropivacaine group(group R)and different doses of dexmedetomidine groups(groups RDl-2),In group R,interscalene brachial plexus block was performed using 0.5%ropivacaine 35 ml(single injection).In groups RDl-2.intemcalene brachial plexus block was induced with a mixture (35 ml)of dexmedetomidine 0.75μg/kg.1.25μg/kg and 0.5%ropivacaine,respectively. The onset time and duration of sensory and motor block were recorded.Tourniquet pain was evaluated using visual analog scale(VAS)at 120 min of stress status. Excessive sedation was measured with Ramsay score in group RDl-2 at different time points.Adverse events were recorded. Results Compared with group R,the onset time was significantly shortened,and the duration of block was prolonged(P<0.05). the severity of tourniquet pain was reduced in group RDl-2(P<0.05).Ramsay score in group RDl-2 were higher . There was no significant difference in the onset time and the duration of block between groups RDland RD2(P>0.05). Compared with group RDl,the severity of tourniquet pain was reduced in group DR2. Ramsay score in group RD2were higher than in group RDl (P<0.05),Some patients developed bradycardia,hypotension or excessive sedation in groups RD2,while no adverse effects were observed in the other groups.Conclusion Dexmedetomidine 0.75 ug/kg mixed with 0.5%ropivacaine 35 ml can be safely and effectively used for braehial plexus block in patients and effectively alleviate the tourniquet pain.