罂粟碱对臂丛神经阻滞作用的临床研究  

Clinical study of the influence of papaverine on brachial plexus block

作　　者：张元信[1] 侯书健[1] 王菊荣 于学军 王延东 康云[1] 

机构地区：[1]解放军第四○一医院全军显微外科中心,青岛266071 [2]解放军第四○一医院药剂科,青岛266071 [3]解放军第四○一医院检验科,青岛266071

出　　处：《中华手外科杂志》2000年第2期105-107,共3页Chinese Journal of Hand Surgery

摘　　要：目的　用不同浓度罂粟碱配伍布比卡因作臂丛麻醉 ,研究其对痛觉和运动的阻滞作用。方法　对 175例无上肢神经、肌腱和掌指关节损伤的住院病人 ,采用双盲法随机分为 5组 :( 1)对照组 :用质量分数为 0 .0 5的布比卡因 ( 1.5mg·kg-1)行臂丛麻醉。 ( 2～ 5 )观察组 :在同量布比卡因中 ,分别加入 0 .2 5mg/ml罂粟碱、0 .12 5mg/ml罂粟碱、0 .0 62 5mg/ml罂粟碱和 0 .0 3 12 5mg/ml的罂粟碱。均选腋路臂丛一针法穿刺麻醉给药 [( 4 0 .0± 2 .6)ml( x±s ,下同 ) ]。比较 5组药物对肌肉收缩、关节活动范围的阻滞作用。结果　与对照组相比 ,2～ 5组的起效时间按顺序逐渐缩短 ,维持时间依序延长 (P <0 .0 5 ) ;肌肉收缩、关节活动范围的阻滞程度按序逐渐增强 ,但均弱于第 1组。结论　罂粟碱有拮抗布比卡因效能的作用 ,可加快阻滞臂丛痛觉神经纤维的时间 ,对运动神经纤维的作用轻微。药物作用和浓度呈正相关。Objective To study the influence of bupivacaine combined with papaverine in different concentrations on sensation and motion in brachial plexus block . Methods 175 cases without nerve, tendon and MPJ injuries were involved in the study, and were randomly divided into five groups with 35 each. In group 1, the control group, 0.25 % bupivacaine (1.5 mg·kg -1) was administered alone. In group 2,3,4 and 5, the experimental groups, the same dosage of bupivacaine combined with descending dilution of papaverine [0.25 mg/ml( 0.15 mg·kg 1), 0.125 mg/ml(0.075mg·kg -1), 0.0625 mg/ml (0.0375mg·kg -1), 0.03125 mg/ml(0.01875mg·kg -1)] were administered respectively. One single injection was used in brachial plexus block through axillary approach, and the dosage was 40 ml ± 2.6 ml( ± s ). The anesthetic effects including muscular contraction power and range of joint motion were observed. Results Compared with group 1, the inducing time became shorter and shorter in the order from group 2 to 5, while the maintenance period and analgesic period became longer and longer ( P < 0.05 ). The anesthetic effect on muscle power and range of joint motion became greater in the ascending order from group 2 to 5. Conclusions Papaverine has an counteraction on bupivacaine. It can accelerate the block of the sensory component of the brachial plexus with minor influence on the motor fibers. The effect is concentration related.

关 键 词：罂粟碱 布比卡因 臂丛 神经根麻醉 

分 类 号：R614.4[医药卫生—麻醉学]