不同剂量地塞米松对罗哌卡因神经阻滞作用的影响  

Effects of different doses of dexamethasone on action of ropivacaine

作　　者：张大志[1] 王怀江[1] 刘永盛 周海滨[1] 

机构地区：[1]北京积水潭医院麻醉科,北京市100035 [2]广州仁爱集团仁爱医院麻醉科

出　　处：《临床麻醉学杂志》2013年第3期213-215,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较不同剂量地塞米松复合罗哌卡因神经阻滞对罗哌卡因阻滞时效的影响。方法 60例内、外踝关节骨折拟行手术患者随机均分为三组。所有患者均在神经刺激器定位下行腰丛-坐骨神经阻滞麻醉。A组:0.4%罗哌卡因50ml;B组:0.4%罗哌卡因50ml加入地塞米松5mg;C组:0.4%罗哌卡因50ml加入地塞米松10mg。观察并记录腰丛、坐骨神经感觉阻滞起效时间、运动阻滞起效时间、感觉阻滞持续时间、运动阻滞持续时间。观察并记录三组患者术后24、48h镇痛泵的舒芬太尼用量、按压总次数和有效次数,记录三组患者术后12、24、36、48h的数字疼痛分级法(NRS)评分及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应的发生率。结果 A组感觉阻滞持续时间和运动阻滞持续时间明显短于B、C组,且B组明显短于C组(P<0.01)。A组患者术后12、24h的NRS评分[(5.2±1.3)、(3.4±0.5)分]明显高于B组的[(1.1±0.3)、(1.6±0.6)]分和C组的[(0.4±0.1)、(1.0±0.2)]分(P<0.05)。A组患者按压总次数和有效次数、48h舒芬太尼用量明显多于B、C组(P<0.05)。结论 5和10mg地塞米松均能延长0.4%罗哌卡因腰丛-坐骨神经阻滞作用时间,且10mg作用更明显。Objective To compare the influences of different doses of dexamethasone on the action of ropivacaine. Methods Sixty patients were randomly allocated into three groups with 20 cases each. Guided by a nerve stimulator, lumbar plexus combined sciatic nerve block was performed with 0.40%ropivacaine 50 ml in group A, 0.4%ropivacaine 50 ml plus dexamethasone 5 mg in group B, or 0.4%ropivacaine 50 ml plus dexamethasone 10 mg in group C. The onset time and duration of sensory and motor blockade were recorded. At 24 and 48 h after surgery, the postoperative sufentanil consumption, the total and effective times of PCA button press were recorded. At 12, 24, 36 and 48 hours after surgery, the pain numerical rating scales （NRS） and the incidences of adverse reactions like nausea, vomit, itches, respiratory depression were also recorded. Results The durations of sensory and motor blockade in group A were significantly shorter than those in groups B and C （P〈0.01）. The pain NRS values [（5.2±1.3）, （3.4±0.5）] of group A were significantly higher than those of group B [（1.1±0.3）,（1.6±0.6）] and group C[（0.4±0.1）, （1.0±0.2）] at 12 and 24 h after surgery （P〈0.05）. The postoperative sufentanil consumption and PCA button press times in group A were more than those of group,; B and C at 48 h after operation （P〈0.05）. Concision Dexamethasone 5 and 10 mg significantly prolonged the action of ropivacaine in lumbar plexus combined sciatic nerve block and dexamethasone 10 mg prolonged the action of ropivacaine more than that of dexamethasone 5 mg.

关 键 词：罗哌卡因 地塞米松 神经阻滞 

分 类 号：R614[医药卫生—麻醉学]