陆庆鹏?阳立?李玉如?何志龙

[摘要] 目的 探討右美托咪定镇静下神经刺激仪在小儿臂丛神经阻滞中的有效性、优越性和安全性。 方法 选取2015年1月～2017年3月我院2～10岁的需行上肢手术的患儿40例，随机分成实验组（A组20例），采用右美托咪定镇静神经刺激仪定位行臂丛麻醉方式；对照组（B组20例）采用传统的气管插管全麻方法。记录麻醉诱导前（基础值T0），麻醉后10min（T1）、20min（手术开始，T2）、60min（T3），手术结束（T4）收缩压（SBP）、舒张压（DBP）和心率（HR），麻醉结束后两组患儿清醒时间、疼痛出现时间，术后麻醉恶心、呕吐及烦躁的并发症情况。 结果 对照组患者的心率、SBP、DBP在 T1时明显低于T0，对照组的心率、SBP、DBP在 T 1～T4时较实验组比有明显的降低（P<0.05）；实验组患儿术后清醒快，疼痛出现慢，与对照组比较差异具有统计学意义（P<0.05）；对照组的患者在手术后发生心动过缓的人数为1例，占总人数的5.0%，有恶心症状的患者为1例，占总人数的5.0%。实验组的患者在手术后发生心动过缓的人数为2例，占总人数的 10.0%，有恶心症状的患者为1例，占总人数的5.0%。两组患者均没有发现术后有呕吐症状的患者，经过统计学分析其中的差异不具有统计学意义（χ2=2.018，P>0.05）。 结论 右美托咪定镇静下神经刺激仪在小儿臂丛神经阻滞的临床效果好，不良反应少，具有明显的优越性和安全性。

[关键词] 右美托咪定；罗哌卡因；小儿；臂丛神经阻滞

[中图分类号] R726.1 [文献标识码] A [文章编号] 2095-0616（2017）10-78-04

Clinical research on nerve stimulator in sedation effect of dexmedetomidine in application of children brachial plexus block

LU Qingpeng1 YANG Li2 LI Yuru3 HE Zhilong1

1.Department of Anesthesiology， Fenggang Hospital of Dongguan， Guangdong， Dongguan 523695， China； 2.Department of Orthopedics， Fenggang Hospital of Dongguan， Guangdong， Dongguan 523695， China； 3.Operation Room， Fenggang Hospital of Dongguan， Guangdong， Dongguan 523695， China

[Abstract] Objective To explore the effectiveness， superiority and safety of nerve stimulator in sedation effect of dexmedetomidine in application of children brachial plexus block. Methods 40 children aged from 2 to 10 years old who received upper limb surgery in our hospital from January 2015 to March 2017 were selected and they were divided into the experimental group （group A） and the control group （group B）， with 20 in each group. The experimental group was used nerve stimulator in sedation effect of dexmedetomidine to locate anesthesia method of brachial plexus. The control group was used traditional tracheal intubation general anesthesia. Systolic blood pressure （SBP）， diastolic blood pressure （DBP） and heart rate （HR） before anesthesia induction （basic value T0）， 10 min after anesthesia （T1）， 20 min after anesthesia （the beginning of operation， T2）， 60 min after anesthesia （T3）， end of operation （T4） were recorded. After anesthesia， recovery time， occurring time of pain and postoperative complications such as anesthesia nausea， vomiting and dysphoria of children in two groups were also recorded. Results In the control group， heart rate， SBP and DBP at T1 were significantly lower than those at T0. Heart rate， SBP and DBP at T1 - T4 of the control group were significantly decreased than those of the experimental group （P<0.05）. In the experimental group， children were awake after operation quickly and pains occur slowly. Difference had statistical significance compared with the control group （P<0.05）. In the control group， there was 1 case with bradycardia after operation accounting for 5.0% of the total number and 1 case with nausea after operation accounting for 5.0% of the total number. In the experimental group， there was 2 cases with bradycardia after operation accounting for 10.0% of the total number and 1 case with nausea after operation accounting for 5.0% of the total number. Patients in two groups were not found to have nausea symptom. By statistical analysis， the difference had no statistical significance （χ2=2.018，P>0.05）. Conclusion Nerve stimulator in sedation effect of dexmedetomidine in application of children brachial plexus block has a good clinical effect and few adverse reactions， which is of obvious superiority and safety.

[Key words] Dexmedetomidine； Ropivacaine； Children； Brachial plexus block

临床上小儿上肢手术多采用插管全麻或基础麻醉后盲探下行臂丛神经阻滞[1]。插管全麻费用高，小儿住院时间长，肺炎等并发症多；盲探下行臂丛阻滞单靠体表解剖难以确定臂丛神经的确切位置。右美托咪定是一种新型的，高选择性的α2 受体激动剂，具有镇静，抗恐惧，抗紧张，降低应激反应，稳定血流动力学的作用，同时不抑制小儿的呼吸。相关研究报道右美托咪定已经广泛应用于小儿的术前、术中的镇静[2-4]。本研究采用右美托咪定镇静下神经刺激仪在小儿臂丛神经阻滞中的临床效果进行研究和调查，现报道如下。……