引用本文:王振宇,杨富国,齐 征,周俊涛,陈 婷.右美托咪啶预防上肢长时间手术中止血带反应的临床观察[J].中国临床新医学,2018,11(9):909-913.
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右美托咪啶预防上肢长时间手术中止血带反应的临床观察
王振宇,杨富国,齐 征,周俊涛,陈 婷
441003 湖北,解放军第477医院麻醉科
摘要:
[摘要] 目的 探讨右美托咪啶预防上肢长时间手术中止血带反应的临床效果。方法 选择2016-01~2017-06在该院行臂丛神经阻滞下长时间手术治疗的断指再植、腕部严重创伤修复患者70例。随机分为观察组36例和对照组34例,两组均在B超引导下完成肌间沟臂丛神经阻滞,麻醉效果确切。观察组在止血带充气后给予右美托咪啶负荷剂量1 μg/kg,泵注10 min,继之以0.4 μg/(kg·h)持续泵注至手术结束前10 min。对照组患者在止血带充气后同样方式持续输注0.9%氯化钠注射液。记录两组止血带充气前(T1)、止血带充气2 h(T2)、止血带充气3 h(T3)、止血带充气4 h(T4)、止血带充气5 h(T5)、止血带充气6 h(T6)时的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)水平变化,分别于T1~T6时间点采用Ramsay镇静评分评估患者镇静、镇痛水平,记录患者术中出现的不良反应,并于术前、术后抽取术侧肘部动脉血测乳酸值;于术前(T1)、术后3 h(T7)、术后24 h(T8)、术后48 h(T9)时记录患者患侧肘静脉血丙二醛(MDA)和超氧化物歧化酶(SOD)浓度。结果 两组T1、T2时MAP、HR、SpO2水平及Ramsay镇静评分比较,差异统计学意义(P>0.05)。观察组T3~T6时MAP、HR水平明显低于对照组(P<0.05),Ramsay镇静评分显著高于对照组(P<0.05)。两组SpO2水平比较差异统计学意义(P>0.05)。观察组中有5例发生窦性心动过缓。观察组术毕时乳酸值较对照组降低(P<0.05);与T1相比,两组在T7、T8、T9时间点MDA均增高,SOD均降低,差异有统计学意义(P<0.05);且观察组MDA均低于对照组,SOD均高于对照组,差异有统计学意义(P<0.05)。结论 右美托咪啶用于长时间上肢手术中可有效防止止血带反应的发生,同时显著改善止血带引起的组织缺氧、减轻止血带所引起的缺血再灌注损伤。
关键词:  右美托咪啶  长时间  止血带反应  臂丛神经阻滞
DOI:10.3969/j.issn.1674-3806.2018.09.17
分类号:R 614
基金项目:
Clinical observation of dexmedetomidine on prevention of tourniquet reaction during long-time operation of upper limbs
WANG Zhen-yu, YANG Fu-guo, QI Zheng, et al.
Department of Anesthesiology, the 477th Hospital of PLA, Hubei 441003, China
Abstract:
[Abstract] Objective To explore the clinical effect of dexmedetomidine on prevention of tourniquet reaction during long-time operation of upper limbs. Methods 70 patients undergoing replantation of severed fingers and severe wrist trauma were treated in our hospital from January 2016 to June 2017 and were treated with brachial plexus block for a long time. They were randomly divided into the observation group(n=36) and the control group(n=34). The two groups were guided by B-ultrasound to achieve intermuscular groove brachial plexus block which had a better effect on anesthesia. The observation group was given dexmedetomidine after tourniquets were inflated, with a dose of 1 μg/kg for 10 min of continuous pumping, followed by 0.4 μg/(kg·h) continuouely pumped to 10 min before the end of the operation. The control group received infusion of 0.9% sodium chloride injection in the same way after tourniquets were inflated. The mean arterial pressure(MAP), heart rate(HR) and blood oxygen saturation(SpO2) before tourniquet inflation(T1), 2 hours(T2), 3 hours(T3), 4 hours(T4), 5 hours(T5) and 6 hours(T6) after tourniquets and Ramsay sedation scores of evaluating sedation and analgesia at different time points of T1~T6, and the incidence of adverse reactions were recorded. The levels of elbow arterial blood lactic acid were detected before and after surgery. The concentrations of malondialdehyde(MDA) and superoxide dismutase(SOD) in the elbow vein were recorded before operation(T1), 3 hours after operation(T7), 24 hours after operation(T8), and 48 hours after operation(T9). Results There were no significant differences in the levels of MAP, HR, SpO2 and Rams scores between the two groups at T1 and T2(P>0.05). The levels of MAP and HR were significantly lower and the Rams scores were significantly higher at T3~T6 in the observation group than those in the control group(P<0.05). There were no significant differences in the levels of SpO2 between the two groups at T3~T6(P>0.05). 5 cases occurred sinus bradycardia in the observation group and their aLac values were lower after operation(P<0.05). Compared with those at T1, MDA increased and SOD decreased at the time points of T7, T8 and T9 in both of the two groups(P<0.05). MDA was significantly lower and SOD was significantly higher in the observation group than those in the control group(P<0.05). Conclusion Dexmedetomidine effectively prevents the occurrence of tourniquet reaction during long-time operation of upper limbs and significantly improves the tissue hypoxia caused by tourniquet and reduces the ischemia-reperfusion injury caused by tourniquet.
Key words:  Dexmedetomidine  Long time  Tourniquet reaction  Brachial plexus block