摘要
目的 比较右美托咪啶、丙泊酚与咪达唑仑辅助于臂丛阻滞麻醉中的镇静效果及对呼吸循环的影响.方法 选择60例ASA Ⅰ ～Ⅱ级拟行上肢手术的患者,随机分为3组,每组各20例.超声引导下臂丛阻滞成功后,右美托咪定组（D组）患者给予右美托咪啶0.5μg/kg静脉泵注10 min后按0.2～0.7 μg/（kg·h）的速率维持;丙泊酚组（P组）给予丙泊酚2 mg/kg静脉注射后以2～4 mg/（kg·h）维持;咪达唑仑组（M组）静脉注射咪达唑仑0.05 mg/kg后以0.05～0.1 mg/（kg·h）维持.调整各组患者的输注速度使镇静目标维持Ramsay镇静评分为3～4分.术中监测不同时间点的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼吸频率（RR）、脑电双频（BIS）指数值、Ramsay镇静评分,并记录术中出现的不良反应.结果 在相同镇静评分下,D组的BIS值明显低于P、M组（P＜0.05）;3组均出现不同程度的血压下降和心率减慢,D组HR下降较P、M组明显（P＜0.05）,P组MAP下降较D、M组明显（P＜0.05）;P、M组RR减慢较D组明显,需要辅助呼吸的比例明显高于D组（P＜0.05）.结论 丙泊酚和咪达唑仑能明显抑制呼吸,而右美托咪啶对呼吸和循环的影响小,辅助于臂丛阻滞麻醉镇静效果比较好,但易诱发心动过缓.
Objective To compare the anaesthetic anesthetic anesthetic anesthetic effect of dexmedetomidine,propofol and midazolam assisted in anesthesia of brachial plexus block and influence of these drugs on respiration and circula- tion. Methods 60 patients （ASA I - lI ） scheduled for upper limb surgery were randomly divided into the three groups and there was 20 cases in every group.Mter success of brachial plexus block under the guidance of ultrasound,patients in the dexmedetomidine group （the group D） were given dexmedetomidine of 0.5 Ig/kg injected by venous pump for 10 minutes and after that the injection was maintained by the speed of 0.2-0.7 p.g/（kg＂ h）;the propofol group （the group P） was given intravenous injection propofol of 2 mg/kg,after that the injection was maintained with 2-4 mg/（kg.h）,the mi- dazolam group （the group M） was given intravenous injection of 0.05 mg/kg,after that the injection was maintained with 0.05-0.1 mg/（kg＂ h）.The infusion rate in each group was adjusted to 3-4 points of sedation score.HR,MAP,SpO2,RR,bis- pectral index （BIS） of different time and sedation score of Ramsay were monitored,adverse reaction were recored during operation. Results With the same sedation score,BIS value in the group was obviously loWer than that in the group P and M （P〈0.05）,BP dropped and HR slowed down in different degree in the three groups and BP in the group D dropped obviously than that in the group P,M （P〈0.05）,MAP in the group dropped obviously than that in the group D and M （P〈0.OS）,RR in the group P and M slowed down obviously than that in the group D （P〈0.05）,and the rate of needding assisted respiration in the group P and M was higher than that in the group D （P〈0.05）. Conclusion Propofol and midazolam can significantly inhibit respiration,while dexmedetomidine applied in brachial plexus block can provide perfect effect of sedation with lighter influence on breath and circulation,but it is easy to induce bradycardia.
出处
《中国当代医药》
2014年第8期109-111,共3页
China Modern Medicine
