逆行锁骨下臂丛神经阻滞患者罗哌卡因的最佳容量  

Ropivacaine volume for ultrasound-guided retrograde infraclavicular brachial plexus block

作　　者：张晓光[1] 李露[1] 廖俊[1] 徐涛[1] 冯磊[1] 李世忠[1] 

机构地区：[1]北京积水潭医院麻醉科,100035

出　　处：《中华医学杂志》2010年第31期2209-2211,共3页National Medical Journal of China

摘　　要：目的 探索超声引导下逆行锁骨下臂丛神经阻滞适宜0.5%罗哌卡因最佳容量.方法 选择北京积水潭医院2010年3至4月择期行上肢手术患者30例,美国医师协会（ASA）Ⅰ/Ⅱ级,在超声引导下逆行锁骨下臂丛神经定位,定位神经后推注0.5%罗哌卡因,以up-and-down序贯分配实验法（阶梯法）计算罗哌卡因的最佳容量,初始容量为36 ml,相邻容量之比为1∶1.2.以感觉神经阻滞效果即VAS〈3为有效.试验终止时不少于5个上下周期.用Dixon-Massey公式计算半数有效容量及95%可信区间,用probit回归分析计算95%有效容量.结果 通过30例病例研究得出逆行锁骨上臂丛阻滞0.5%罗哌卡因的半数有效容量为23.6 ml,95%可信区间为21.3～26.2 ml.95%有效容量为32.3 ml.结论 序贯法简便、高效,适用于局麻药半数有效容量的测定.超声引导下逆行臂丛神经阻滞0.5%罗哌卡因的最佳容量为30 ml.Objective The aim of this study was to determine the medium effective volume required to produce an effective retrograde infraclavicular block using an ultrasound （US）-guided technique.Methods Thirty adults undergoing elective upper limb surgery received a US-guided retrograde infaclavicular block.The initial concentration of 0.5% ropivacaine injected was 30 ml,which was subsequently varied at a ratio volume （EV50） was determined using the Dixon and Massey up-and-down method.The effective volume in 95% of patients （ EV95 ） was calculated using probit regression.Results The medium effective volume and calculated effective volume in50% and 95% of patients were 23.6 ml （95% confidence interval,21.3-26.2ml） and 32.3 ml,respectively.No patient required a general anesthesia.Conclusion The appropriate volume of 0.5% ropivacaine required for US-guided retrograde infraclavicular block was 30 ml in clinical practice.

关 键 词：臂丛神经阻滞 超声引导 逆行锁骨下 罗哌卡因 半数有效容量 

分 类 号：R614[医药卫生—麻醉学]