摘要
目的观察不同剂量的右美托咪定在处理上肢止血带反应中的临床应用比较。方法选择ASA（美国麻醉师协会）Ⅰ-Ⅱ级上肢外伤后需用止血带的手术患者共75例,随机分为3组,每组25例。臂丛神经阻滞后,D1组给予右美托咪定负荷量1μg/kg,用输液泵15min泵入,后以0.4μg/（kg·h）维持;D2组给予右美托咪定负荷量1μg/kg,用输液泵15min泵入,后以0.7μg/（kg·h）维持;对照组（F组）静脉注射氟芬合剂半量后,按D组输注方法输入等容量的生理盐水。记录麻醉前（基础值T1）、臂丛阻滞后5min（T2）、负荷量输注完即刻（T3）,上止血带后15min（T4）,上止血带后60min（T5）,手术结束时（T6）的MAP、HR、SPO2、RR,记录VAS（视觉模拟评分法）评分和不良反应发生情况。结果用药后各时点RR、SPO2与用药前比较,差异不显著（P〉0.05）;D1,D2用药后各时点MAP较用药前有所下降,D2组在T4、T5时MAP下降明显,与同组T1、T2及同期F组比较,差异有统计学意义（P〈0.05）;D1、D2组患者T4、T5时HR较同组T1、T2时及F组显著降低（P〈0.05）,且D2组下降更明显,部分患者需用阿托品干预,患者嗜睡情况也明显增多（P〈0.05）;D1、D2组VAS评分在上止血带后15min、60min时明显低于F组,差异有统计学意义（P〈0.05）。结论右美托咪定能有效减轻上肢止血带的不良反应,以0.4μg/（kg.h）的泵注速率维持较佳。
Objective To observe the clinical effect of different doses dexmedetommidine for upper limb＇s reaction by tourniquet. Methods Seventy-five ASA Ⅰ-Ⅱ patients who required tourniquet surgery were randomly divided into group D1 , group D2 and group F. There were 25 cases in every group. Blood pressure, heart rate, the pain visual analog scores （ VAS ） , untoward effect were observed and recorded before and after anesthesia and intravenous injection were recorded in surgery. Results The breathing rate and oxygen saturation changes of three groups before treatment, on every time point after treatment were not statistically significant. The blood pressure of D1 and D2 group after tourniquet application 15 min, tourniquet application 60 rain was lower than before, the difference of D2 group was statistically significant. The blood pressure and heart rate changes of D2 and F group after tourniquet application 15 min, tourniquet application 60 min was statistically significant. The heart rate of D1 and D2 group after tourniquet application 15 min, tourniquet application 60 min was lower than before, the differences were statistically significant. D2 group decreased more obviously, some patients were treated by atropine. The VAS of D1 and D2 group after tourniquet application 15min, tourniquet application 60min was less than F group, the different was statistically significant. Conclusion Dexmedetomidine can effectively reduce the upper limb＇s adverse reaction of tourniquet, especially by the 0.4μg/（ kg.h ）pump injection rate.
出处
《中国继续医学教育》
2014年第6期129-131,共3页
China Continuing Medical Education
关键词
右美托咪定
止血带反应
Dexmedetommidine, Reaction by tourniquet
