摘要
Abstract
Objective To investigate the impact of dexmedetomidine combined with local anesthetics used in peripheral nerve block on the tourniquet-induced hemodynamic and oxidative stress injury.Methods We enrolled 122 patients who underwent upper limb surgery in Zhejiang Provincial People's Hospital from May 2015 to February 2016 with interscalene brachial plexus block and tourniquet inflation pressure more than 45 min and randomized them to the control group (group C,n =39) receiving B ultrasound-guided interscalene brachial plexus block without dexmedetomidine,intravenous infusion of dexmedetomidine (group Ⅳ,n =40) receiving B ultrasound-guided interscalene brachial plexus block with intravenous infusion of dexmedetomidine,and peripheral nerve block with dexmedetomidine group (group P,n =43) receiving B ultrasound-guided interscalene brachial plexus block with dexmedetomidine combined with local anesthetics.The changes of mean arterial pressure (MAP) and mean heart rate (HR) in each group were recorded at basic state (T01),before the tourniauet inflated (T02),30 min after the tourniauet inflated (T11),45 min after the tourniauet inflated (T12),immediately after the release of the tourniquet (T21),5 min after the release of the tourniquet (T22),10 min after the release of the tourniquet (T23).The maximum MAP and minimum HR during the period of tourniauet inflation (T13) were observed and recorded.ELISA was used to detect the levels of malondialdehvde (MDA) and superoxide dismutase (SOD) in serum at T01,T21,T22 and T23.Results At T02,T1 1,T12 and T13,group Ⅳ had lower MAP than group C,group P had lower MAP than group C but higher MAP than group Ⅳ;at T21,group Ⅳ had higher MAP than group C,group P had higher MAP than group C but lower MAP than group Ⅳ (P＜0.05).At T01,T02,T11,T12,Tl3,T21,T22 and T23,group Ⅳ showed lower mean HR than group C (P ＜ 0.05).At T02,T11,T12,T13,T21,T22 and T23,group P demonstrated less mean HR than group C (P ＜ 0.05) but more mean HR than group Ⅳ (P ＜0.05).MDA levels measured at T22 and T23 were higher than those measured at T01 in all the groups (P ＜0.05).SOD levels measured at T22 and T23 were lower than those measured at T01 in group C and group P (P ＜0.05).SOD levels measured at T23 were lower than those measured at T01 in group Ⅳ (P ＜0.05).At T22 and T23,group Ⅳ had lower MDA levels than group C,and group P had lower MDA levels than group C but higher MDA levels than group Ⅳ (P ＜ 0.05);group Ⅳ had higher SOD levels than group C,and group P had higher SOD levels than group C but lower SOD levels than group Ⅳ (P ＜ 0.05).Conclusion Dexmedetomidine combined with local anesthetics for interscalene brachial plexus block can effectively reduce the tourniquet-related responses and oxidative stress injury,but the effects are not as good as those of intravenous infusion of dexmedetomidine.关键词
抗交感神经药/右美托咪定/臂丛/止血带Key words
Sympatholytics/Dexmedetomidine/Brachial plexus/Tourniquets分类
医药卫生
