|
| 地塞米松复合右美托咪定对罗哌卡因臂丛神经阻滞效果和血浆皮质醇的影响 |
| Effects of intravenous dexamethasone combined with dexmedetomidine on ropivacaine brachial plexus block and plasma cortisol |
| |
| DOI：10.12089/jca.2020.09.002 |
| 中文关键词: 地塞米松 右美托咪定 臂丛神经阻滞 术后镇痛 血浆皮质醇 |
| 英文关键词: Dexamethasone Dexmedetomidine Brachial plexus block Postoperative analgesia Plasma cortisol concentration |
| 基金项目: |
|
| 摘要点击次数: 2507 |
| 全文下载次数: 869 |
| 中文摘要: |
目的 观察地塞米松复合右美托咪定静脉注射对肌间沟臂丛神经阻滞效果和血浆皮质醇的影响。
方法 选择择期肩关节镜手术的患者75例，男45例，女30例，年龄18～65岁，ASA Ⅰ或Ⅱ级。采用随机数字表法随机分为三组：静脉注射生理盐水组（C组），静脉注射地塞米松0.1 mg/kg组（D1组）和静脉注射地塞米松0.1 mg/kg复合右美托咪定1.0 μg/kg组（D2组），每组25例。三组患者入室后超声引导下行肌间沟臂丛神经阻滞，给予0.5%罗哌卡因20 ml。臂丛神经阻滞完成后，三组分别将干预药物用生理盐水稀释至50 ml于麻醉诱导前30 min内静脉输注完毕。记录患者的运动、感觉阻滞持续时间，记录术后24 h内需补救镇痛率，术后1、6、12、18、24 h的疼痛VAS评分，麻醉诱导前和术后1、6、12、18、24 h的血浆皮质醇浓度，记录围术期不良反应的发生情况。
结果 与C组比较，D1组和D2组运动、感觉阻滞持续时间均明显延长，24 h内补救镇痛率明显降低（P<0.05），D1组术后12、18 h VAS评分明显降低（P<0.05），D2组术后6、12、18、24 h VAS评分明显降低（P<0.05），D1组和D2组术后1、6、12、18、24 h血浆皮质醇浓度明显降低（P<0.05）。与D1组比较，D2组感觉阻滞持续时间明显延长，术后18、24 h VAS评分明显降低，术后6、12、18、24 h血浆皮质醇浓度明显下降（P<0.05）。三组患者围术期不良反应差异无统计学意义。
结论 静脉注射地塞米松复合右美托咪定能优化肩关节镜患者臂丛神经阻滞的术后镇痛效果，减轻围术期应激反应。 |
| 英文摘要: |
Objective To observe the effects of dexamethasone combined with dexmedetomidine intravenous infusion on interscalene brachial plexus block and plasma cortisol.
Methods Seventy-five patients undergoing shoulder arthroscopy, 45 males and 30 females, aged 18-65 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into three groups: intravenous normal saline group (group C), intravenous dexamethasone 0.1 mg/kg group (group D1), and the combination of intravenous dexamethasone 0.1 mg/kg and dexmedetomidine 1.0 μg/kg group (group D2), 25 cases in each group. All patients were given 20 ml of 0.5% ropivacaine for brachial plexus block under ultrasound guidance. The intervention drugs were diluted to 50 ml normal saline and the intravenous infusion was completed within 30 min after brachial plexus block. Duration of motor and sensory block, frequency of patients requiring rescue analgesia within 24 h were recorded. VAS scores were recorded at 1, 6, 12, 18, 24 h postoperatively. Blood cortisol levels at pre-induction and 1, 6, 12, 18, 24 h after surgery were recorded. Perioperative adverse reactions were recorded.
Results Compared with group C, the duration of motor and sensory block were significantly longer , and the frequency requiring rescue analgesia were significantly reduced in group D1 and group D2 (P < 0.05), the VAS scores of group D1 at 12, 18 h after surgery were significantly decreased (P < 0.05), and the VAS scores of group D2 at 6, 12, 18, 24 h after surgery were significantly decreased (P < 0.05). The plasma cortisol concentrations in group D1 and group D2 at 1, 6, 12, 18, 24 h were significantly decreased (P < 0.05). Compared with group D1, the duration of sensory block was nearly doubled (P < 0.05), the VAS scores of group D2 were lower at 18, 24 h after surgery (P < 0.05), and the plasma cortisol concentrations significantly decreased at 6, 12, 18, 24 h postoperatively (P < 0.05). There were no significant differences in the incidence of perioperative adverse reactions among the three groups.
Conclusion Co-administration of intravenous dexamethasone with dexmedetomidine can significantly improve postoperative analgesic effect and reduce stress response after brachial plexus nerve block in patients undergoing arthroscopic shoulder surgery. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
