国际麻醉学与复苏杂志   2018, Issue (2): 5-5
    
右美托咪定辅助用于臂丛神经阻滞时对脑电双频指数及术后疼痛的影响
赵晓红, 高玉峰, 王惠淑, 胡宝吉1()
1.上海市浦东医院麻醉科
Effects of dexmedetomidine on the bispectral index and postoperative pain as an adjuvant to levobupivacaine for brachial plexus block
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摘要:

目的 评价右美托咪定(dexmedetomidine, Dex)对左布比卡因超声引导下行锁骨上臂丛神经阻滞麻醉BIS值的影响。 方法 80例拟择期行上肢手术的患者,ASA 分级Ⅰ、Ⅱ级,采用随机数字表法分成两组(每组40例):对照组(C组),局部麻醉药为含1 ml生理盐水的0.5%左布比卡因30 ml;Dex组(D组),局部麻醉药为含100 μg Dex(1 ml)的0.5%左布比卡因30 ml。麻醉方法均为超声引导下行锁骨上臂丛神经阻滞。观察指标:术前及麻醉后1 h内的BIS值和Ramsay评分、术后第1次需求镇痛药的时间(first rescue analgesia after the surgeries, TAR)。 结果 与C组比较,D组患者从臂丛神经阻滞麻醉后20 min开始BIS值明显降低(P<0.05),Ramsay评分明显增高(P<0.05);TAR也明显长于C组(P<0.05)。 结论 Dex能够显著降低臂丛神经阻滞麻醉时的BIS值,使患者术中安静合作,能够延长术后镇痛时间,减少额外镇痛药需求量。

关键词: 右美托咪定; 脑电双频指数; Ramsay镇静评分; 锁骨上部; 臂丛神经阻滞
Abstract:

Objective To evaluate the effects of dexmedetomidine(Dex) on BIS of electroencephalograph in patients received supraclavicular brachial plexus blocking with levobupivacaine under ultrasound-assisted guidance. Methods Eighty patients undergoing distal arm and forearm surgeries and classified into ASA classⅠorⅡ were divided into two groups. One was control group (C group), in which patients received supraclavicular brachial plexus blocking with 30 ml levobupivacaine and 1 ml normal saline. The other was Dex group, in which patients(D group) received supraclavicular brachial plexus blocking with 30 ml levobupivacaine and 100 μg Dex in 1 ml normal saline. The supraclavicular brachial plexus blocking was performed under the guidance of ultrasound. BIS value, Ramsay sedation scores, and time to first rescuing analgesic after the surgeries(TAR) were recorded. Results In D group, the BIS values decreased significantly until 20 min after the brachial plexus blocking (P<0.05), but the Ramsay sedation scores was significantly increased(P<0.05), in comparison with C group. Time to administration of the first rescuing analgesic after the surgeries for pain relief was significantly delayed in D group than in C group(P<0.05). Conclusions Perineural dexmedetomidine administration for supraclavicular brachial plexus blocking with levobupivacaine had sedative effects that correspond to drops of BIS values, and significantly prolonged the duration of postoperative analgesia.

Key words: Dexmedetomidine; Bispectral index; Ramsay sedation scores; Supraclavicular part of brachial plexus; Brachial plexus block