| 丁依依,叶克平,杨亦平,符新春,王文伟.肌间沟臂丛神经阻滞中应用右美托咪定超前镇痛的临床价值[J].中国临床保健杂志,2018,21(3):320-322. |
| 肌间沟臂丛神经阻滞中应用右美托咪定超前镇痛的临床价值 |
| Observation on the application of dexmedetomidine for preemptive analgesia in muscle ditch brachial plexus block |
| 投稿时间：2018-01-07 |
| DOI：10.3969/J.issn.1672-6790.2018.03.009 |
| 中文关键词: 神经传导阻滞 右美托咪定 疼痛管理 |
| 英文关键词: Nerve block Dexmedetomidine Pain management〖FL |
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| 中文摘要: |
| 目的 探讨右美托咪定超前镇痛在肌间沟臂丛神经阻滞中的应用价值。方法 选取行肌间沟臂丛神经阻滞麻醉的上肢手术患者108例为研究对象,以随机数字表法分组,观察组与对照组各54例,观察组术前5 min静脉滴注0.5 μg/kg右美托咪定,对照组术前5 min给予等剂量0.9%氯化钠注射溶液。观察两组麻醉阻滞情况、术后疼痛程度、患者自控镇痛(PCA)用药剂量及不良反应发生情况。结果 观察组感觉阻滞起效时间[(8.33±1.25)min比(10.05±1.62)min,t=6.177,P<0.001]与运动阻滞起效时间[(16.17±2.48)min比(20.32±3.16)min,t=7.592,P<0.001]同对照组比较均明显缩短,麻醉维持时间[(8.43±0.86)min比(7.29±0.92)min,t=6.652,P<0.001]与对照组比较显著延长,差异有统计学意义(P＜0.05)；术后2 h[(1.45±0.21)分比(1.51±0.24)分,t=1.383,P=0.170]两组视觉模拟评分(VAS)比较,差异无统计学意义(P＞0.05),术后4 h[(1.78±0.33)分比(2.29±0.41)分,t=7.121,P<0.001]、术后6 h[(2.56±0.37)分比(3.62±0.48)分,t=12.853,P<0.001]、术后12 h[(3.53±0.39)分比(4.75±0.51)分,t=13.964,P<0.001]、24 h[(4.62±0.64)分比(5.90±0.76)分,t=9.467,P<0.001]观察组VAS评分与对照组比较均明显较低,差异有统计学意义(P＜0.05)；观察组24 h内PCA用药剂量同对照组比较,明显较低,差异有统计学意义(P＜0.05)；观察组术后不良反应发生率[(4例(7.41%)比14例(25.93%),t=6.667,P=0.010]与对照组比较明显较低,差异有统计学意义(P＜0.05)。结论 在肌间沟臂丛神经阻滞中应用右美托咪定超前镇痛,可提高麻醉阻滞效果,减轻术后疼痛,降低术后阿片类药物使用剂量,减少不良反应发生。 |
| 英文摘要: |
| Objective To investigate the value of dexmedetomidine for preemptive analgesia in muscle ditch brachial plexus block.Methods 108 patients of upper limb surgery with muscular ditch brachial plexus block anesthesia were selected as subjects and divided into the observation group and the control group according to the random number table,with 54 cases in each group.The observation group received intravenous drip of 0.5 μg/kg dexmedetomidine 5 min before the operation,and the control group received the same dose of normal saline 5 min before the operation.The anesthetic block,the degree of postoperative pain,the dosage of PCA and the adverse reactions were observed in the two groups.Results The onset time of sensory block in the observation group [(8.33±1.25)min vs (10.05±1.62)min,t=6.177,P<0.001] and motor block onset time [(16.17±2.48)min vs (20.32±3.16)min,t=7.592,P<0.001] were significantly shorter compared with the control group,and the duration of anesthesia maintenance [(8.43±0.86)min vs (7.29±0.92)min,t=6.652,P<0.001] was significantly longer than that that of the control group(P<0.05),with the difference statistically significant (P<0.05);the difference in the comparison of visual analogue score(VAS) of two groups at 2h [(1.45±0.21) points vs (1.51±0.24) points,t=1.383,P=0.170] after surgery was not statistically significant (P>0.05),and the VAS of the observation group was less than that of the control group at 4 h[(1.78±0.33) points vs (2.29±0.41) points,t=7.121,P<0.001],6 h[(2.56±0.37) points vs (3.62±0.48) points,t=12.853,P<0.001],12 h[(3.53±0.39) points vs (4.75±0.51) points,t=13.964,P<0.001],24 h[(4.62±0.64) points vs (5.90±0.76) points,t=9.467,P<0.001] after operation,and the difference was statistically significant (P<0.05);the dosage of PCA in the observation group was significantly lower than that in the control group in 24 h (P<0.05),and the difference was statistically significant (P<0.05);the incidence of adverse reaction in the observation group [(4 cases (7.41%) compared with 14 cases (25.93%),t=6.667,P=0.010] was significantly lower compared with the control group,and the difference was statistically significant (P<0.05). ConclusionThe application of dexmedetomidine for preemptive analgesia in muscle ditch brachial plexus block can improve anesthetic block effect,relieve postoperative pain,reduce the dosage of opioid and the occurrence of adverse reactions. |
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