本文選題：右美托咪啶 + 腰叢神經(jīng)��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：觀察右美托咪啶對于羅哌卡因復(fù)合利多卡因腰叢聯(lián)合坐骨神經(jīng)阻滯的影響,評估右美托咪啶復(fù)合羅哌卡因及利多卡因用于腰叢聯(lián)合坐骨神經(jīng)阻滯的麻醉效果及安全性。 方法：選擇大連醫(yī)科大學(xué)附屬第一醫(yī)院擇期行單側(cè)大隱靜脈高位結(jié)扎剝脫手術(shù)的患者26例,ASA（American Society of Anesthesiologists,美國麻醉醫(yī)師協(xié)會）分級Ⅰ-Ⅱ級,年齡31-71歲,其中男性17例,女性9例。將患者隨機分為實驗組（D組）和對照組（R組）,每組各13例。入室后所有患者均予監(jiān)測,面罩吸氧3L/分,并靜脈給予芬太尼0.05mg,咪達唑侖1mg。兩組患者由同一名麻醉醫(yī)師行腰叢聯(lián)合坐骨神經(jīng)阻滯。實驗組（D組）行腰叢神經(jīng)阻滯給予0.25%羅哌卡因+0.5%利多卡因+右美托嘧啶0.5μ g/Kg共35ml,坐骨神經(jīng)阻滯給予0.5%羅哌卡因+1%利多卡因+右美托嘧啶0.5μ g/Kg共15ml；對照組（R組）腰叢神經(jīng)阻滯給予0.25%羅哌卡因+0.5%利多卡因共35ml,坐骨神經(jīng)阻滯給予0.5%羅哌卡因+1%利多卡因共15ml。觀察記錄患者在麻醉穿刺前（T0）,麻醉完成后10分鐘（T1）,手術(shù)開始時（T2）,麻醉完成后1小時（T3）,手術(shù)結(jié)束時（T4）的平均動脈壓（MAP）,心率（HR）及血氧飽和度（SpO2）,記錄腰叢及坐骨神經(jīng)的感覺和運動阻滯起效時間及持續(xù)時間,觀察術(shù)中出現(xiàn)的不良反應(yīng)（如惡心嘔吐,心動過緩等）并及時處理,術(shù)中如主訴疼痛給予芬太尼0.05mg靜脈注射，，如疼痛難以忍受則改為全麻。 結(jié)果：①術(shù)后隨訪所有患者均未發(fā)生不良反應(yīng)或麻醉相關(guān)并發(fā)癥,無一例改變麻醉方式,未出現(xiàn)惡心嘔吐,D組中出現(xiàn)兩例術(shù)中心率低于50次/分,經(jīng)靜脈給予阿托品0.4-0.8mg處理后好轉(zhuǎn),R組中1例患者主訴疼痛,予靜脈分次追加芬太尼共0.15mg鎮(zhèn)痛處理后順利完成手術(shù)。②實驗組于T1,T2,T3時間點測量的MAP值低于T0時所測值,實驗組于T1,T2,T3時間點測量的HR值低于T0時所測量值,差異有統(tǒng)計學(xué)意義（P0.05或P0.01）；實驗組于T1-T4測量HR與MAP值均低于對照組,差異有統(tǒng)計學(xué)意義（P0.05或P0.01）。③實驗組腰叢神經(jīng)及坐骨神經(jīng)的感覺阻滯起效時間和運動阻滯起效時間與對照組無明顯差異,實驗組腰叢及坐骨神經(jīng)的感覺阻滯持續(xù)時間和運動阻滯持續(xù)時間均長于對照組,差異有統(tǒng)計學(xué)意義（P0.01）。 結(jié)論右美托咪啶加入羅哌卡因復(fù)合利多卡因用于腰叢聯(lián)合坐骨神經(jīng)阻滯是安全的,右美托咪啶可以延長腰叢聯(lián)合坐骨神經(jīng)的感覺及運動阻滯持續(xù)時間。
[Abstract]:Aim: to observe the effect of dexmetomidine on ropivacaine combined with lidocaine combined with sciatic nerve block and to evaluate the anesthetic effect and safety of dexmetomidine combined with ropivacaine and lidocaine for lumbar plexus combined with sciatic nerve block. Methods: 26 patients (age 31-71 years old, 17 males and 9 females) with ASA American Society of Anesthesiologists, (American Association of Anestheticists) were selected for selective exfoliation of unilateral great saphenous vein in the first affiliated Hospital of Dalian Medical University. The patients were randomly divided into experimental group D (n = 13) and control group (n = 13). All the patients were monitored, the 3L/ score of oxygen was absorbed by mask, and fentanyl 0.05 mg and midazolam 1 mg were given intravenously. The two groups were treated with lumbar plexus combined with sciatic nerve block by the same anesthesiologist. Group D (group D) received 0.25% ropivacaine 0.5% lidocaine 0.5 渭 g/Kg for 35 ml, sciatic nerve block 0.5% ropivacaine 1% lidocaine 0.5 渭 g/Kg for 15 ml, control group 1% ropivacaine 0.5% lidocaine 0.5 渭 g/Kg for 15 ml; control group 1% ropivacaine 0.5% lidocaine 0.5 渭 g/Kg The lumbar plexus nerve block was given 0.25% ropivacaine 0.5% lidocaine 35 ml and the sciatic nerve block 0.5% ropivacaine 1% lidocaine 15 ml. The mean arterial pressure (MAPP, HRT) and blood oxygen saturation (SPO _ 2) were recorded 10 minutes after anesthesia, 10 minutes after anesthesia, 1 hour after anesthesia, and at the end of operation. The data of lumbar plexus and sciatic nerve were recorded. Onset and duration of sensory and motor block, Adverse reactions (such as nausea, vomiting, bradycardia, etc.) were observed and treated in time. Fentanyl 0.05mg was given intravenously during the operation, and if the pain was unbearable, it was changed to general anesthesia. Results there were no adverse reactions or anaesthesis-related complications in all the patients followed up after 1: 1, and no change in anaesthesia. In group D, the rate of operation center was less than 50 times in group D with no nausea and vomiting. After intravenous administration of atropine 0.4-0.8mg, one patient in group R complained of pain. After intravenous administration of fentanyl combined with 0.15mg analgesia, the MAP value of experimental group was lower than that of T0 group at T _ (1) T _ (2) T _ (3). The HR value of the experimental group was lower than that of the T0 group at T _ 1 / T _ 2 T _ 3 time point, the difference was statistically significant (P 0.05 or P 0.01), and the HR and MAP values of the experimental group were lower than those of the control group at the time point of T _ 1 and T _ 2T _ 3. There was no significant difference in the onset time of sensory block and motor block of lumbar plexus nerve and sciatic nerve between the experimental group and the control group. The duration of sensory block and motor block of lumbar plexus and sciatic nerve in experimental group was longer than that in control group (P 0.01). Conclusion it is safe to use dexmetomidine plus ropivacaine combined with lidocaine for lumbar plexus combined with sciatic nerve block. Dexmetomidine can prolong the duration of sensory and motor block of lumbar plexus combined with sciatic nerve.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

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