Effects Of Ropivacaine Combined With Dexmedetomidine On Myocardial Stress During Perioperative Ischemia Reperfusion During Replantation Of Amputated Finger

Objective:To investigate the effect of Ropivacaine combined with Dexmedetomidine on myocardial injury induced by limb ischemia-reperfusion in severed finger replantation.Methods:60 patients with emergency finger replantation were randomly divided into three groups:Ropivacaine group（Ropi group）,Ropivacaine combined with Dexmedetomidine group 1（Ropi+DEX group 1）and Ropivacaine combined with Dexmedetomidine group 2（Ropi+DEX group 2）.20 patients in each group were treated with ultrasound-guided axillary brachial plexus nerve.Block.Ropi group was given 0.5%Ropivacaine 30 ml,Ropi+DEX group 1 was given 0.5%Ropivacaine and Dexmedetomidine 0.5μg/kg for 30 ml,Ropi+DEX group 2 was given 0.5%Ropivacaine and Dexmedetomidine 1.0μg/kg for 30 ml.Three groups of heart rate variability（HRV）,plasma malondialdehyde（MDA）,and plasma cardiac troponin（CTnT）in 3 groups of T₀（before anaesthesia）and T₁（6h after limb reperfusion）were recorded and NRS analgesia scores at 2h,4h,6h,12h after the end of anesthesia.Results:Compared with Ropi group,HRV in Ropi+DEX1 group was significantly lower（p<0.05）,and MDA and CTnT in plasma were significantly lower（p<0.05）.There was no significant difference in NRS analgesia score at 2h after anesthesia（p>0.05）.The NRS analgesia score was significantly lower at 4h after anesthesia（p<0.05）,and the NRS analgesia score was not significantly changed after 6h and 12h anesthesia（p>0.05）.The HRV in Ropi+DEX2 group was significantly lower（p<0.05）.MDA and CTnT were significantly decreased（p<0.05）;there was no significant difference in NRS analgesia scores at 2h after anesthesia（p>0.05）,but NRS analgesia scores were significantly lower at 4h and 6h after anesthesia（p<0.05）,anesthesia 12h The change in post-NRS analgesia score was not significant（p>0.05）.Compared with Ropi+DEX1 group,HRV was significantly lower in Ropi+DEX2 group（p<0.05）.MDA and CTnT in plasma were significantly lower（p<0.05）.There was no significant difference in NRS analgesia scores at 2h and 4h after anesthesia.（p>0.05）,but the NRS analgesia score was significantly lower after 6h anesthesia（p<0.05）.There was no significant change in analgesia score after NRS after 12h anesthesia（p>0.05）.Conclusion:The combination of Ropivacaine and Dexmedetomidine in patients with replantation of severed fingers can reduce myocardial stress injury induced by limb ischemia-reperfusion and prolong the maintenance time of anesthesia;and can reduce the perioperative stress response.And dose dependent.