| 摘要: |
| 目的通过罗哌卡因复合不同剂量右美托咪啶对老年患者臂丛神经阻滞，观察患者神经阻滞效果和术后睡眠的情况，探讨老年患者上肢手术麻醉的合理方案。方法对择期行上肢前臂桡侧手术的150例患者按随机数字表法分为5组，每组30例。对照组（R0组）患者单次注射0.375%罗哌卡因25ml；研究组（RD1~4组）单次注射0.375%罗哌卡因复合不同右美托咪啶混合液25ml，右美托咪啶的剂量分别为0.2滋g/kg（RD1组）、0.5滋g/kg（RD2组）、0.7滋g/kg（RD3组）、1滋g/kg（RD4组）。在超声引导下行肌间沟臂丛神经阻滞，阻滞后记录给药前（T0）、给药后15min（T1）、30min（T2）、60min（T3）、90min（T4）和120min（T5）心率（HR）、平均动脉压（MAP）、Ramsay镇静评分。观察手术侧臂丛感觉和运动阻滞起效时间及持续时间。根据视觉模拟评分法（VAS）同时评估各组给药后24h内手术侧上肢疼痛程度。分别评估术前晚、术后当晚匹兹堡睡眠质量指数。记录每组患者不良反应发生情况。结果与R0组比较，RD2组T3~5及RD3~4组给药后T2~5的HR显著下降（P＜0.05）；RD2组T2~4及RD3~4组T2~5的MAP均明显降低（均P＜0.05）；RD1~2组T2~5及R3~4组T1~5Ramsay评分均明显高于R0组（均P＜0.05）；与R0组比较，RD2~4组感觉起效时间和RD3~4组运动阻滞起效时间均显著加快（均P＜0.05），而RD2~4感觉和运动阻滞持续时间则明显延长（P＜0.05）；术后6hRD4组及术后8、12、24hRD2~4组VAS疼痛评分均低于R0组（均P＜0.05）；术后当晚匹兹堡睡眠质量指数RD2~4小于R0组（P＜0.05）；RD1~4组总不良反应发生率分别为0%、3.7%、7.1%、22.2%（P＞0.05）。结论老年手术患者臂丛神经阻滞中辅用右美托咪啶可缩短阻滞起效时间，延长阻滞持续时间，减少术后止痛药的使用，改善术后睡眠质量；0.5~0.7滋g/kg是合适复合剂量且安全可靠。 |
| 关键词: 老年患者 臂丛神经阻滞 罗哌卡因 右美托咪啶 睡眠质量 |
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| Application of ropivacaine combined with different dose dexmedetomidine for brachial plexus block and its effect on postoperative sleep quality in elderly patients |
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YU Dehua, YAN Min
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the Second Affiliated Hospital，Zhejiang University School of Medicine
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| Abstract: |
| Objective To evaluate the application of ropivacaine combined with different dose dexmedetomidine for brachial plexus block and its effect on postoperative sleep quality in elderly patients. Methods One hundred and fifty patients scheduled for elective upper extremity surgery were recruited and randomly allocated into 5 groups (n=30 in each group). In group R0, patients were given 25 ml (75 mg) of 0.375% ropivacaine, while in groups RD1~4, patients were given 25 ml (75mg) of 0.375% ropivacaine in conjunction with dexmedetomidine 0.2μg/kg (RD1), 0.5滋g/kg (RD2), 0.7滋g/kg (RD3) or 1.0滋g/kg(RD4), respectively. Heart rate (HR), mean arterial blood pressure (MAP), and Ramsay Sedation Score were observed before anesthesia (T0), 15 min (T1), 30 min (T2), 60 min (T3), 90 min (T4), 120 min (T5) after anesthesia. The onset time and duration of sensory and motor block were recorded. The pain intensity was assessed by visual analogue score (VAS) during 24h after operation. Sleep quality was evaluated at night before and after operation using Pittsburgh Sleep Quality Index Rating Scale. The side effects and complications were observed and recorded. Results In comparison with group R0, the HR at T3~5 in group RD2 and at T2~5 in groups RD3~4 were significantly lower (P＜0.05), the levels of MAP at T2~4 in group RD2 and at T2~5 in groups RD3~4 were also significantly lower (P＜0.05). Ramsay sedation score at T2~5 in groups RD1~2 and at T1~5 in groups RD3~4 were significantly higher compared to R0 (P＜0.05). Onset times of sensory block in groups RD2~4 and onset times of motor block in groups RD3~4 were significantly shorter than those in group R0 (P＜0.05), the durations of sensory and motor block in groups RD2~4 were significantly
longer than that in group R0(P＜0.05). Groups RD2~4 at 8, 12, 24h after operation had better pain control than group R0 assessed by VAS score. RD2~4 had better sleep quality at postoperative night compared to R0 group (P＜0.05). The incidence rates of side effects in groups R0, RD1~4 were 0, 0, 5%, 10% and 30% , respectively (P＜0.01). Conclusion Dexmedetomidine combined with ropivacaine can accelerate onset time and prolong duration of brachial plexus block for elderly patients. Furthermore, it reduces the amount of postoperative analgesic use, and improves sleep quality of patients. The study indicates that 0.5~0.7滋g/kg
dexmedetomidine is a safe and optimal dose for brachial plexus block. |
| Key words: Dexmedetomidine Ropivacaine Brachial plexus block Elderly patients Sleep quality |
