瑞马唑仑与右美托咪定在超声引导臂丛神经阻滞断指再植术中的麻醉效果比较

doi:10.3969/j.issn.1006-5725.2023.24.017

Abstract

Abstract:

Objective To compare the anesthetic effects of remazolam and dexmedetomidine assisted sedation in the operation of finger replantation under ultrasound guided brachial plexus block. Methods 60 patients undergoing severed finger replantation were randomly divided into remazolam group （group R） and a dexmedetomidine group （group D） by random number table method， with 30 cases in each group. Both groups received a single brachial plexus block under ultrasound guidance. Group R was injected with remazolam 0.1 mg/kg， followed by 1 mg/（kg·h） pump until 10 min before the end of the operation. In group D， a load dose of 0.5 μg/kg of dexmedetomidine was injected， followed by continuous infusion at a rate of 0.5 μg/（kg·h） until 10 min before the end of surgery. The MAP， HR and SpO₂ values of the two groups were compared when the patients entered the room （T₀）， the wound was cleaned and disinfected （T₁）； the tourniquet was upper （T₂）； the operation began （T₃）； the tourniquet was relaxed （T₄）； and the operation ended （T₅）. MOAA/S scores and BIS values were compared between the two groups at different time. The time from the beginning of medication to the absence of consciousness and the time of consciousness recovery after drug withdrawal were compared between the two groups. Blood lactic acid （Lac） before applying tourniquet and 15 min after relaxing tourniquet were compared between the two groups. The occurrence of intraoperative adverse reactions was recorded in the two groups. Results The MAP of patients in group R had little fluctuation at each time during the operation， and the MAP of patients in group D was significantly increased at T₁， T₂， T₃ and T₀ moments and at the same time as that in group R （P < 0.05）； HR in group R was stable at all times， and HR in group D significantly slowed down at T₁， T₂ and at the same time with group R （P < 0.05）. Patients in both groups achieved ideal sedation during the operation （MOAA/S score ≤ 3 points）， and the MOAA/S score of patients in group R at T₅ minutes after drug withdrawal was higher than that at other moments of the same group and group D （P < 0.05）； the BIS value of group R was higher than that of group D （P < 0.05）. The loss time and recovery time of consciousness in group R were shorter than those in group D （P < 0.05）. The incidence of intraoperative hypertension and bradycardia in group D was significantly higher than that in group R， and the incidence of respiratory depression in group R was higher than that in group D （P < 0.05）. There was no significant change in lactate value between the two groups （P > 0.05）. Conclusion Remazolam and dexmedetomidine can satisfy sedation in brachial plexus nerve block for replantation of severed finger under ultrasound guidanc. Compared with dexmedetomidine， remazolam has better sedation control， stable hemodynamics， low incidence of circulatory adverse events.

Key words: remazolam, dexmedetomidine, brachial plexus block, replantation of severed finger, ultrasound guidance, anaesthesia

CLC Number:

R614

Yao SONG,Yuao QIN,Xue XIA,Lin LI,Xuejun. ZOU. Comparison of the anesthetic effect of remazolam and dexmedetomidine in ultrasound-guided brachial plexus block for replantation of severed finger[J]. The Journal of Practical Medicine, 2023, 39(24): 3243-3248.

Figures/Tables 6

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References 28

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组别	例数	性别（例）		年龄（岁）	体质量指数（kg/m²）	手术时间（min）	ASA分级（例）
组别	例数	男	女	年龄（岁）	体质量指数（kg/m²）	手术时间（min）	Ⅰ级	Ⅱ级
R组	30	25	5	37.5 ± 7.31	25.07 ± 3.53	143.03 ± 10.84	19	11
D组	30	23	7	37.8 ± 6.88	25.8 ± 3.22	145.93 ± 11.14	20	10
χ ²/t值		0.417		0.164	0.832	1.022	0.073
P值		0.519		0.871	0.409	0.311	0.787

指标	组别	T₀	T₁	T₂	T₃	T₄	T₅
MAP（mm/Hg）	R组	73.00 ± 3.01	75.1 ± 3.38	75.23 ± 3.01	76.10 ± 2.96	78.53 ± 2.86	78.27 ± 3.31
MAP（mm/Hg）	D组	72.30 ± 3.00	82.00 ± 3.13^*#	82.20 ± 3.14^*#	82.43 ± 3.19^*#	78.27 ± 3.07	78.47 ± 3.23
	t值	0.903	8.209	8.761	7.965	0.348	0.237
	P值	0.370	< 0.001	< 0.001	< 0.001	0.729	0.814
HR（次/min）	R组	80.20 ± 3.41	81.10 ± 3.45	81.17 ± 3.90	80.80 ± 3.51	80.47 ± 3.38	80.40 ± 3.79
HR（次/min）	D组	79.67 ± 3.31	63.47 ± 3.03^*#	64.6 ± 3.15^*#	80.27 ± 3.96	79.90 ± 3.51	79.83 ± 3.33
	t值	0.614	21.056	18.118	0.553	0.637	0.615
	P值	0.541	< 0.001	< 0.001	0.583	0.527	0.541
SpO₂（%）	R组	99.10 ± 0.84	94.17 ± 0.95^*	98.97 ± 0.81	99.00 ± 0.83	99.17 ± 0.70	99.33 ± 0.71
SpO₂（%）	D组	99.37 ± 0.81	99.07 ± 0.87^#	98.97 ± 0.76	98.97 ± 0.76	99.03 ± 0.89	99.10 ± 0.80
	t值	1.249	20.854	0.000	0.162	1.979	2.510
	P值	0.217	< 0.001	> 0.999	0.872	0.053	0.015

项目	组别	例数	T₁	T₂	T₃	T₄	T₅
MOAA/S评分	R组	30	2.20 ± 0.41	2.03 ± 0.32^*	1.97 ± 0.41^*	1.93 ± 0.45^*	4.20 ± 0.85^*#
	D组	30	2.13 ± 0.35	2.10 ± 0.31	1.97 ± 0.49^*	1.90 ± 0.31^*	3.33 ± 0.66^*#
	t值		0.684	0.826	0.000	0.336	4.419
	P值		0.497	0.412	1.000	0.738	< 0.001
BIS	R组	30	73.60 ± 4.49	72.20 ± 4.04^*	71.33 ± 3.74^*	74.60 ± 2.71^*	74.87 ± 3.58
	D组	30	68.37 ± 3.92^#	67.37 ± 3.56^*#	66.30 ± 2.96^*#	69.73 ± 2.16^*#	70.73 ± 3.24^*#
	t值		4.809	4.920	5.775	7.683	4.691
	P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	LOC	ROC
R组	30	5.47 ± 1.04	12.6 ± 2.85
D组	30	7.77 ± 1.36	18.07 ± 3.03
t值		7.366	7.203
P值		< 0.001	< 0.001

组别	例数	高血压	低血压	心动过速	心动过缓	呼吸抑制	体动反应
R组	30	2（6.67）	1（3.33）	4（13.33）	3（10.00）	9（30.00）	8（26.67）
D组	30	10（33.33）	2（6.67）	2（6.67）	14（46.67）	2（6.67）	8（26.67）
χ² 值		6.667	0.000	0.185	9.932	5.455	0.000
P值		0.010	> 0.999	0.667	0.002	0.020	> 0.999

Comparison of the anesthetic effect of remazolam and dexmedetomidine in ultrasound-guided brachial plexus block for replantation of severed finger

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组别	例数	首次上止血带	最后一次松止血带后15 min
R组	30	0.54 ± 0.09	0.60 ± 0.14
D组	30	0.54 ± 0.08	0.57 ± 0.08
t值		0.426	0.954
P值		0.671	0.344

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