摘要
目的 探讨颈臂丛神经阻滞辅助镇静完成短小肩关节镜手术的安全性和可行性.方法 选取择期行肩关节镜手术患者90例,用随机数字表法均分为A、B、C三组.入手术室后行超声引导肌间沟臂丛+颈浅丛神经阻滞,注入0.25%罗哌卡因+1%利多卡因25mL.A组右美托咪定负荷量后泵注维持,B组丙泊酚诱导后泵注维持,均在术毕前10min停止,C组无镇静药物.比较三组在入室时(T_(0))、药物负荷剂量完成后(T_(1))、手术切皮(T_(2))、手术开始5min(T_(3))、手术开始15min(T_(4))、停止药物泵注后5min(T_(5))、术毕即刻(T_(6)),出手术室(T_(7))8个时点患者的血流动力学指标变化、SpO_(2)、脑电双频谱指数(BIS),苏醒时Ramsay评分、术野评分、术者满意度、手术时间及不良反应等.结果 A、B组血压和心率均下降,B组血压在T_(1)-T(4)时低于A组(P<0.05),A组心率在T_(1)-T_(7)时慢于B组(P<0.05);仅B组SpO_(2)在术中下降(P<0.05);A、B组BIS在T_(1)-T_(7)时下降,B组小于A组(P<0.05);A组苏醒时Ramsay评分低于B组(P<0.05);C组术野评分和术者满意度低于A、B组(P<0.05),但各组手术时间差异无统计学意义(P>0.05);A、B组主要不良反应分别为心动过缓和呼吸抑制,C组有7例因主诉疼痛不耐受或体动影响手术,变更了麻醉方案.结论 对于短小肩关节镜手术,单纯颈臂丛神经阻滞辅助镇静可作为全身麻醉安全和有效的替代方案,可在临床上更多的应用与推广.
Objective To investigate the safety and feasibility of cervical brachial plexus block assisted sedation for completing short shoulder arthroscopy.Methods 90 patients undergoing elective shoulder arthroscopy were collected and divided into three groups by random number table:the group A(n=30),the group B(n=30)and the group C(n=30).Ultrasound-guided brachial plexus+superficial cervical plexus block(interscalene approach)was performed affer admssion,and a total of 0.25%ropivacaine+1%lidocaine 25 mL was injected.Dexmedetomidine was given in the group A after loading dose and pumped for maintenance,and the propofol was used in the group B after induction and pumped for maintenance,both of which were stopped 10 minutes before the end of the operation.The group C had no sedative drugs.The three groups of patients were compared for changes in hemodynamic indices,SpO2,and BIS at the time of admission(T0),after the completion of drug load dose(T1),skin incision(T2),5 minutes of operation(T3),15 minutes of operation(T4),5 minutes after stopping drug pump(T5),immediately after operation(T6),and exiting the operation room(T7).Other changes include Ramsay score at awakening,operative field scores,operator satisfaction,duration of surgery,and adverse effects.ResultsThe blood pressure and heart rate were decreased in both group A and B,the blood pressure in the group B was lower than that in the group A from T1 to T4,with statistical significance(P<0.05),and the heart rate in the group A was lower than that in the group B,with statistical significance(P<0.05).Only SpO2decreased in the group B during the operation,with statistical significance(P<0.05).BIS decreased in both group A and B from TI to T7,and that in the group B was lower than that in the group A,with statistical significance(P<0.05).Ramsay score at awakening was lower in group A than group B,with statistical significance(P<0.05).Comparison ofoperative field scores and operator satisfaction in all three groups was lower in group C than in group A and B,with statistica
出处
《浙江临床医学》
2023年第2期262-264,共3页
Zhejiang Clinical Medical Journal
基金
宁波市科技计划项目(202003N4246)。
关键词
右美托咪定
丙泊酚
臂丛阻滞
麻醉
镇静
Dexmedetomidine
Propofol
Brachial plexus block
Anesthesia
Sedation
