右美托嘧啶联合神经阻滞在骨科下肢手术中的应用.docVIP

1. 研究设计中应说明给予右美托咪定具体时间，其给予负荷剂量维持量与观察时间点手术开始即刻T2，手术开始后15minT3，手术开始后30minTT4，手术开始后45minT5的关系，这可能直接影响到研究果。2. 研究结果中应说明两组神经阻滞的效果，是否有效，是否具有可比性。 请您在word文档的第一页逐条回复专家审稿后提出的问题，并在word文档中以其他颜色突出您修改的内容。 意见如下：1. 由于本文中以止血带是否耐受作为一个重要的观察指标，请就该操作进行两组间的比较，如止血带压力，患者的出血量比较等。2. 请进一步规范修改英文摘要。3.加引本刊文献1条。 Orthopaedic surgery below the knee joint. Methods A total of 40 people were divided randomly into two groups: group D(Femoral nerve sciatic nerve block combined with DEX) and group C(Femoral nerve sciatic nerve block combined with placebo).All the patients receive nerve block under ultrasound guide,and then the patients in group D received a loading dose of DEX 1ug*kg-1 (With physiological saline dilution to 20 ml)for 20 minutes and the continues infusion of 0.2ug.kg.-1h-1 until the end of surgery . The patients in group C received same regime of 20ml physiological saline as control.Medical tourniquet with pressure of 70 kpa was used to reduce bleeding.A dose of fentanyl 100ug was added to those who could not tolerate the tourniquet pain. The changes of MAP ,SPO2 ,HR ,RR and Ramsay scores were recorded before(T0) and after(T1) anesthesia ; at the beginning of surgery(T2) ,and 15min(T3),30min（T4），45min(T5) during the surgery. The tourniquet intolerance time and blood loss was recorded, as well as adverse reaction. Results The number of patients needed fentanyl in group D was less than that in group C(3 vs 11 respectively).During operation time (T2-T5),HR and RR in group D decreased significantly(P0.05 vs T0) and were lower than those in group C.MAP in group C increased in the mean time significantly. When compared to TO and was higher than those in group D. During the time T3 and T5, the Ramsay scores in group D were statistically higher than those in group C(P0.05) .The tourniquet tolerance time is longer in group D than that in group C(P0.05). Conclusion In Orthopaedic surgery below the knee joint with lower extremity nerve block anesthesia, DEX has safe sedative effect by