【摘要】：目的觀察不同負(fù)荷劑量的鹽酸右美托咪定(dexmedetomidine, Dex)對(duì)超聲引導(dǎo)下臂叢神經(jīng)阻滯患者的鎮(zhèn)靜效應(yīng)及其對(duì)血流動(dòng)力學(xué)的影響,探究Dex輔助臂叢神經(jīng)阻滯的最佳負(fù)荷劑量。方法選擇80例擇期在臂叢神經(jīng)阻滯下行上肢(手部、腕部、前臂)手術(shù)的患者,ASA Ⅰ級(jí)-Ⅱ級(jí)。按隨機(jī)數(shù)字法隨機(jī)分為Dex(D1、D2、 D3)組和咪達(dá)唑侖(M)組,每組20例患者。四組患者分別于超聲引導(dǎo)經(jīng)肌間溝入路臂叢神經(jīng)阻滯前10分鐘,靜脈泵注負(fù)荷劑量的Dex0.3μg·kg~(-1)、 Dex0.5μg·kg~(-1)、 Dex0.8μg·kg~(-1)和咪達(dá)唑侖0.05mg·-kg~(-1),輸注完負(fù)荷劑量后Dex組和M組分別給予Dex0.5μg ·kg~(-1)·h~(-1)和咪達(dá)唑侖0.05mg·kg~(-1)·h~(-1)維持鎮(zhèn)靜。記錄入室基礎(chǔ)值(T0)、鎮(zhèn)靜藥物給藥后5min(T1)、臂叢神經(jīng)阻滯前即刻(T2)、臂叢神經(jīng)阻滯后即刻(T3)、鎮(zhèn)靜藥物給藥后20min(T4)、鎮(zhèn)靜藥物給藥后30min(T5)、鎮(zhèn)靜藥物給藥后40min(T6)和鎮(zhèn)靜藥物給藥后60min(T7)的MAP、HR、SpO2及警覺/鎮(zhèn)靜(OAA/S)評(píng)分。記錄發(fā)生低血壓、心動(dòng)過緩等不良反應(yīng)及需要芬太尼的患者例數(shù)。結(jié)果各組間MAP、HR差異無統(tǒng)計(jì)學(xué)意義(P0.05),M組在T5時(shí)Sp02低于其他三組(P0.05)。D1組各時(shí)間點(diǎn)OAA/S評(píng)分與TO時(shí)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05), D2, D3, M組各時(shí)間點(diǎn)OAA/S評(píng)分均低于各組TO時(shí)(P0.05)；D1組OAA/S評(píng)分在T2-T7時(shí)高于M組(P0.05),D2組OAA/S評(píng)分與M組相比差異無統(tǒng)計(jì)學(xué)意義(P0.05),D3組OAA/S評(píng)分在T3-T5時(shí)明顯低于M組(P0.05)。Dex組低血壓的發(fā)生率與負(fù)荷劑量成正相關(guān),各組術(shù)中發(fā)生心動(dòng)過緩、需要芬太尼的患者例數(shù)差異均無統(tǒng)計(jì)學(xué)意義。結(jié)論靜脈輸注Dex0.5μg ·kg~(-1)后以0.5μg·kg~(-1)·h~(-1)速率維持可提供臂叢神經(jīng)阻滯患者良好的鎮(zhèn)靜作用,且血流動(dòng)力學(xué)較穩(wěn)定、不良反應(yīng)較小。
[Abstract]:Objective to observe the sedation effect and hemodynamics of dexmetidine hydrochloride (dexmedetomidine, Dex) in patients with brachial plexus block guided by ultrasound, and to explore the optimal load dose of Dex assisted brachial plexus block. Methods 80 patients with upper limb (hand, wrist, forearm) undergoing brachial plexus block were selected for ASA grade 鈪，

本文編號(hào)：2194400