局麻药佐剂右美托咪定与硫酸镁对超声引导下腋路臂丛神经阻滞的影响-现代医学

局麻药佐剂右美托咪定与硫酸镁对超声引导下腋路臂丛神经阻滞的影响

单位：哈尔滨医科大学附属第二医院麻醉科, 黑龙江哈尔滨 150086

分类号：R614

出版年·卷·期（页码）：2017·36·第八期（1140-1145）

摘要：

目的：比较右美托咪定或硫酸镁作为佐剂加入相同浓度利多卡因与罗哌卡因合剂对超声引导下腋路臂丛神经阻滞的起效时间、阻滞时间、血流动力学、镇静程度、术后镇痛时间及镇痛药物用量的影响。方法：选择2015年10月~2016年7月择期手部及前臂手术的患者共60例，ASA分级I~Ⅱ级，采用随机数字表法均分为3组：生理盐水对照组（C组）、右美托咪定组（D组）、硫酸镁组（M组），各组患者均接受超声引导下腋路臂丛神经阻滞。C组：1%利多卡因/0.25%罗哌卡因30 ml+0.9%生理盐水3 ml；D组：1%利多卡因/0.25%罗哌卡因30 ml+0.75 μg·kg^-1右美托咪定稀释至3 ml；M组：1%利多卡因/0.25%罗哌卡因30 ml+10%硫酸镁3 ml。记录入室（T₀）、阻滞后5 min （T₁）、10 min （T₂）、15 min （T₃）、20 min （T₄）、25 min （T₅）、30 min （T₆）、45 min （T₇）、60 min （T₈）的收缩压（SAP）、舒张压（DAP）、心率（HR）、血氧饱和度（SpO₂）、脑电双频指数（BIS）值；超声引导下腋路臂丛神经阻滞的感觉及运动起效时间、持续时间、镇痛时间及术后48 h氟比洛芬酯的用量。结果：D组与M组的感觉阻滞时间、运动阻滞时间和镇痛时间较C组明显延长（P<0.05），且D组时间明显长于M组，两组之间差异有统计学意义（P<0.05）；D组与M组术后48 h氟比洛芬酯的用量明显少于C组（P<0.05），但两组之间差异无统计学意义（P>0.05）；三组的感觉及运动阻滞起效时间无明显差异（P>0.05）。D组的BIS值在T₃~T₈较C组与M组下降明显（P<0.05），M组BIS值在T₅~T₈较C组下降明显（P<0.05）；与C组相比，D组SAP在T₃~T₈明显下降，M组在T₄~T₈明显下降，均具有统计学意义（P<0.05），但两组间差异无统计学意义（P>0.05）；D组DAP在T₄~T₈明显下降，M组DAP较C组也有所下降，但差异无统计学意义（P>0.05）；与C组相比，D组HR在T₂~T₈明显下降（P<0.05），且在T₃~T₅较M组下降明显（P<0.05），M组HR较C组有所下降，但差异无统计学意义（P>0.05），所有患者术中SpO₂均在97%以上。D组与M组术后48 h氟比洛芬酯用量较C组明显减少（P<0.05），D组用量少于M组，但两组之间差异无统计学意义（P>0.05）。结论：0.75 μg·kg^-1右美托咪定与10%硫酸镁3 ml分别加入相同浓度的利多卡因罗哌卡因合剂可使超声引导下腋路臂丛神经阻滞的阻滞时间及镇痛时间延长，减少术后氟比洛芬酯的用量，能够提供良好的术中镇静，稳定血流动力学，且右美托咪定的作用优于硫酸镁。

Objective: To compare the effects of dexmedetomidine or magnesium sulfate as local anesthetic adjuvants added to the same concentration of lidocaine/ropivacaine mixtures by ultrasound-guided axillary brachial plexus block(BPB).Methods: Sixty ASA Ι or Ⅱ patients, scheduled for forearm or hand surgery were randomly allocated into three groups:Group C(n=20)received 30 mL of 0.25% ropivacaine/1% lidocaine+3 ml of 0.9% NaCl; Group D(n=20) received 30 mL of 0.25% ropivacaine/1% lidocaine+3 ml of 0.75 μg·kg^-1 dexmedetomidine. Group M(n=20) received 30 mL of 0.25% ropivacaine/1%lidocaine+3 ml of 10% magnesium sulfate. Hemodynamic changes, SpO₂, BIS values were recorded at baseline(T₀), 5 min(T₁), 10 min(T₂), 15 min(T₃), 20 min(T₄), 25 min(T₅), 30 min(T₆), 45 min(T₇)and 60 min(T₈) after the injection of local anesthetics(LAs), onset time and duration of sensory and motor blocks, the analgesic time and the volume dose of rescue analgesics within 48 h were recorded. Results: Compared to group C, the duration time of sensory and motor blocks and analgesic time were significantly longer in group D and group M(P<0.05), and those were longer in group D than group M, the difference was statistically significance(P<0.05). The volume dose of flurbiprofen was significantly reduced in group D and group M(P<0.05), but no significant difference was detected between the two groups(P>0.05). There were no significant differences in onset time in all the three groups.(P>0.05). In group D, BIS value was significantly decreased than that of group C and group M from T₃ till T₈(P<0.05); compared to group C, BIS values also significantly decreased in group M from T₅ till T₈(P<0.05). In group D, SAP level was significantly declined from T₃ till T₈ in group M, to be specific, significantly declined from T₅ till T₈. DAP, HR levels were significantly declined in group D compared to group C(P<0.05), in group M the DAP and HR were also declined but no significant difference was detected(P>0.05). During the surgery, SpO₂ of all patients was above 97%. The volume dose of flurbiprofen treatment were significantly reduced in group D compared with those in group C. Conclusions: Dexmedetomidine or magnesium sulfate added to lidocaine/ropivacaine mixtures prolongs the duration of sensory and motor blocks of ultrasound-guided axillary brachial plexus block, extends analgesic time, reduces the volume dose of postoperative analgesics and exerts a considerable sedative effect without significantly affecting the onset time.

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