CAJ | 학술논문

目的：探讨不同剂量右美托咪定对罗哌卡因臂丛神经阻滞效果的影响。方法100例择期行上肢手术患者按随机数字表法分为罗哌卡因组（R 组）及不同剂量右美托咪定混合罗哌卡因组（RD1～RD4组）共5组各20例。采用超声引导下肌间沟臂丛神经阻滞，R 组单次注射0．4％罗哌卡因30 ml；RD1～RD4组分别单次注射含右美托咪定0．5μg／kg（RD1组）、0．8μg／kg（RD2组）、1．0μg／kg（RD3组）、1．2μg／kg（RD4组）的0．4％罗哌卡因30 ml。记录各组感觉和运动神经阻滞起效时间、持续时间、术中 Ramsay 镇静评分及心血管事件、呼吸抑制、气胸等不良反应发生情况。结果 RD1～RD4组较 R 组、RD2～RD4组较 RD1组感觉和运动神经阻滞起效时间缩短，持续时间延长，差异均有统计学意义（P ＜0．05）。 Ramsay 镇静评分比较，RD1～RD4组高于 R 组，RD3、RD4组高于 RD1和 RD2组，差异均有统计学意义（P ＜0．05）。 RD3组与 RD4组分别有1例和2例出现心动过缓和低血压，其余各组未见不良反应发生。结论右美托咪定0．8μg／kg 混合0．4％罗哌卡因30 ml 可安全、有效地用于臂丛神经阻滞。
목적：탐토불동제량우미탁미정대라고잡인비총신경조체효과적영향。방법100례택기행상지수술환자안수궤수자표법분위라고잡인조（R 조）급불동제량우미탁미정혼합라고잡인조（RD1～RD4조）공5조각20례。채용초성인도하기간구비총신경조체，R 조단차주사0．4％라고잡인30 ml；RD1～RD4조분별단차주사함우미탁미정0．5μg／kg（RD1조）、0．8μg／kg（RD2조）、1．0μg／kg（RD3조）、1．2μg／kg（RD4조）적0．4％라고잡인30 ml。기록각조감각화운동신경조체기효시간、지속시간、술중 Ramsay 진정평분급심혈관사건、호흡억제、기흉등불량반응발생정황。결과 RD1～RD4조교 R 조、RD2～RD4조교 RD1조감각화운동신경조체기효시간축단，지속시간연장，차이균유통계학의의（P ＜0．05）。 Ramsay 진정평분비교，RD1～RD4조고우 R 조，RD3、RD4조고우 RD1화 RD2조，차이균유통계학의의（P ＜0．05）。 RD3조여 RD4조분별유1례화2례출현심동과완화저혈압，기여각조미견불량반응발생。결론우미탁미정0．8μg／kg 혼합0．4％라고잡인30 ml 가안전、유효지용우비총신경조체。
Objective To investigate the influence of different doses of dexmedetomidine on block effect of ropivacaine brachi -al plexus block.Methods One hundred patients undergoing upper limb operation were divided into ropivacaine group (group R)and ropivacaine mixed with different doses of dexmedetomidine groups (group RD1 ~RD4 ) according to the random number table .Each group had 20 cases.An inter-scalene brachial plexus block was performed guided by ultrasound .In the group R,0.4%ropivacaine 30 ml was injected while 0.4%ropivacaine 30 ml mixed with different doses of dexmedetomidine were injected (0.5 μg/kg in the group RD1 , 0.8 μg/kg in the group RD2 ,1.0 μg/kg in the group RD3 and 1.2 μg/kg in the group RD4 ,respectively).The onset time of sensory and motor nerve block,the time of duration,Ramsay sedation score during operation and the adverse reactions (cardiovascular events,re-spiratory depression and pneumothorax )were compared among the groups .Results The onset time of sensory and motor nerve block in the groups RD1 ~RD4 was shortened and the time of duration time was extended when compared to the group R .Moreover,the onset time in the groups RD2 ~RD4 was shortened and the duration time was extended when compared to the group RD 1 .The differences were statistically significant(P <0.05).Ramsay sedation score in the groups RD 1 ~RD4 was higher than that in the group R ,and the score in the groups RD3 and RD4 was higher than that in the RD 1 and RD2.The differences were also statistically significant (P <0.05).There was one case in the group RD 3 and two cases in the group RD 4 with bradycardia and hypotension during the operation .Conclusion It is safe and effective when use dexmedetomidine 0.8 μg/kg mixed with 0.4%ropivacaine 30 ml in brachial plexus block .