不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果  

Appropriate concentration of ropivacalne for differential sensory and motor block of brachial plexus

作　　者：李挺[1] 曹亲亲[1] 李军[1] 

机构地区：[1]温州医学院附属第二医院麻醉科,325027

出　　处：《中华麻醉学杂志》2010年第12期1462-1464,共3页Chinese Journal of Anesthesiology

基　　金：浙江省温州市科技局基金（Y20070016）

摘　　要：目的探讨不同浓度罗哌卡因用于臂丛神经感觉与运动分离阻滞的效果。方法择期上肢手术患者90例，ASA分级Ⅰ～Ⅲ级，年龄16～75岁，体重40-85kg。均在超声引导联合神经刺激器辅助定位下行腋路臂丛神经阻滞，根据不同罗哌卡因浓度分为3组（n=30）：0．15％罗哌卡因组（A组），0．10％罗哌卡因组（B组），0．05％罗哌卡因组（c组）。于注射局麻药后10、30、60、240min（T1-4）时记录感觉与运动分离阻滞情况、感觉阻滞完善情况和臂丛神经阻滞成功情况，术毕时评定麻醉效果。记录手术时间、镇痛时间。结果与A组比较，B组T1.2时感觉阻滞完善率较低（P〈0．05），L3.4时感觉阻滞完善率差异无统计学意义（P〉0．05），感觉与运动分离阻滞率较高（P〈0．01），c组T1.2时感觉与运动分离阻滞率较低（P〈0．01），B。时感觉与运动分离阻滞率差异无统计学意义（P〉0．05），各时点感觉阻滞完善率较低（P〈0．01）。与B组比较，c组各时点感觉阻滞完善率、感觉与运动分离阻滞率均较低（P〈0．01）。A组麻醉效果优于B组，B组麻醉效果优于c组（P〈0．01），与A组和B组比较，c组臂丛神经阻滞成功率较低（P〈0．01），A组与B组差异无统计学意义（P〉0．05）。结论0．10％罗哌卡因用于臂丛神经阻滞可产生感觉与运动分离阻滞效果。Objective To determine the appropriate concentration of ropivacaine for differential sensory and motor block of brachial plexus. Methods Ninety ASA Ⅰ -Ⅲ patients aged 16-75 yr weighing 40-85 kg undergoing upper extremity operation under axillary brachial plexus block were randomly divided into 3 groups according to the concentration of ropivacaine used for the block （ n = 30 each） ： group A 0.15% ropivacaine; group B 0.10% ropivacaine and group C 0.05% ropivacaine. Axillary brachial plexus block was performed using ultrasound guidance and electric nerve stimulation. Sensory and motor block were assessed and recorded at 10, 30, 60 and 240 min after local anesthetic injection （T1-4 ）. The rate of adequate sensory block, the rate of differential sensory and motor block （the areas innervated by radial, median and ulnar nerves were numb but the patients could still move their elbow, wrist and fingers） and effectiveness of the block （excellentcompletely no pain; good -slight pain, iv fentanyl was needed; poor rescue brachial plexus block was needed or general anesthesia was induced）. Operation time and duration of analgesia and success rate of the block were recorded. Results 0.15 % ropivacaine produced excellent or good block and no failure in group A. The rate of differential sensory and motor block was significantly higher in group B （0.10% ropivacaine） than in group A. The effect of block with 0.05% ropivacaine was unsatisfactory in group C. Conclusion Axillary brachial plexus block with 0.10 % ropivacaine can induce differential sensory and motor block in the majority of patients.

关 键 词：雄甾烷醇类 臂丛 神经传导阻滞 

分 类 号：R614[医药卫生—麻醉学]