右美托咪定静脉或局部用药对腰丛联合坐骨神经阻滞效果的影响
| 作者: |
1张芳芳,
2刘振杰,
3陈玉杰,
4王晓娜,
5王跃起,
1王春光
1 保定市第一中心医院麻醉科，河北 保定 071000 2 保定市第一中心医院神经外科，河北 保定 071000 3 保定市第一中心医院内镜中心，河北 保定 071000 4 保定市第二医院麻醉科，河北 保定 071051 5 保定市妇幼保健院麻醉科，河北 保定 071000 |
| 通讯: |
王春光
Email: wangchunguang@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.07.024 |
| 基金: | 保定市科技计划项目(2041ZF090)。 |
摘要
目的：比较右美托咪定静脉或局部用药对腰丛联合坐骨神经阻滞效果的影响。方法：拟行髋部骨折手术的老年患者90例，美国麻醉医师学会(American Society of Anesthesiologists，ASA)分级II或III级，随机分为三组。A组给予0.4%罗哌卡因溶液50 mL行腰丛联合坐骨神经阻滞，静脉给予0.9%氯化钠注射液50 mL；B组给予0.4%罗哌卡因溶液50 mL行腰丛联合坐骨神经阻滞，静脉给予含0.5 μg/kg右美托咪定的0.9%氯化钠注射液50 mL；C组给予含0.5 μg/kg右美托咪定的0.4%罗哌卡因混合溶液50 mL行腰丛联合坐骨神经阻滞；静脉给予0.9%氯化钠注射液50 mL。记录三组患者感觉和运动阻滞起效时间、感觉和运动阻滞持续时间、镇痛时间，以及低血压、低氧血症、心动过缓及过度镇静等不良反应发生情况。结果：C组感觉、运动持续时间明显长于A、B组(P<0.05)；C组镇痛时间显著长于A、B组(P<0.05)；A、B两组感觉、运动持续时间及镇痛时间差异无统计学意义(P>0.05)；三组感觉、运动起效时间差异无统计学意义(P>0.05)。B组较A、C组心动过缓、过度镇静发生率高(P<0.05)；A、C两组心动过缓及过度镇静发生率差异无统计学意义(P>0.05)；三组低血压及低氧血症发生率差异无统计学意义(P>0.05)。结论：右美托咪定局部用药可改善腰丛联合坐骨神经阻滞效果，避免心动过缓、过度镇静等不良反应的发生，效果优于静脉途径用药。
关键词：
右美托咪定；罗哌卡因；腰丛；坐骨神经；神经阻滞
Effect on efficacy of lumbar plexus combined with sciatic nerve block by dexmedetomidine intravenous or local administration
CorrespondingAuthor: WANG Chunguang Email: wangchunguang@163.com
DOI: 10.3978/j.issn.2095-6959.2021.07.024
Foundation: This work was supported by the Project of Science and Technology Plan of Baoding, China (2041ZF090).
Abstract
Objective: To compare the effect on the efficacy of lumbar plexus combined with sciatic nerve block by administration of dexmedetomidine intravenously or locally. Methods: Ninety elderly patients undergoing surgery of hip fracture, with American Society of Anesthesiologists (ASA) stage II or III, were randomly devided into three groups. Lumbar plexus and sciatic nerve block was performed with 0.4% ropivacaine 50 mL and patients were injected intravenously with 0.9% sodium chloride injection 50 mL in group A. Lumbar plexus and sciatic nerve block was performed with 0.4% ropivacaine 50 mL and patients were injected intravenously with 0.9% sodium chloride injection 50 mL containing dexmedetomidine (0.5 μg/kg) in group B. Lumbar plexus and sciatic nerve block was performed with 0.4% ropivacaine 50 mL containing dexmedetomidine (0.5 μg/kg) and patients were injected intravenously with 0.9% sodium chloride injection 50 mL in group C. The onset time of sensory block and motor block, durations of sensory block and motor block, and duration of analgesia were recorded. The incidences of adverse effects such as hypotension, hypoxemia, bradycardia and over-sedation were also recorded. Results: The sensory and motor durations were longer in group C compared with those in the group A and B (P<0.05). The duration of analgesia was longer in group C compared with that in group A and B (P<0.05). There was no difference in sensory block, motor block, and analgesia durations between group A and B (P>0.05). There was no difference in the onset time of sensory block and motor block in all three groups (P>0.05). The incidence of over-sedation and bradycardia was higher in group B compared with that in group A and C (P<0.05). There was no difference in over-sedation and bradycardia between group A and C (P>0.05). There was no difference in hypotension and hypoxemia in all three groups (P>0.05). Conclusion: Local administration of dexmedetomidine can improve the effect of lumbar plexus combined with sciatic nerve block and avoid the occurrence of bradycardia and excessive sedation, and is superior to intravenous administration of dexmedetomidine.
Keywords：
dexmedetomidine; ropivacaine; lumbar plexus; sciatic nerve; nerve block