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作 者:张庆伟[1] 孙合亮 朱敬明[1] 金文杰[1] 李竞进[1] ZHANG Qing-wei(Department of anesthesiology,Jiangsu provincial people's hospital,Nanjing,Jiangsu,210029,China)
出 处:《齐齐哈尔医学院学报》2018年第15期1805-1807,共3页Journal of Qiqihar Medical University
摘 要:目的比较相同剂量不同浓度罗哌卡因行腋路臂丛阻滞时对动静脉人工内瘘血流量的影响。方法选择终末期肾病需行动静脉人工内瘘成形术的患者90例,随机分为三组,分别采用0.25%(L组)、0.375%(M组)、0.5%(H组)浓度的罗哌卡因75 mg在B超引导下行腋路臂丛神经阻滞,记录疼痛消失时间及疼痛恢复时间,观察麻醉前和麻醉后30 min前臂造瘘处桡动脉和头静脉内径变化以及桡动脉血流量变化,并于动静脉人工内瘘成形术后3 h、7 d、8 w测量造瘘口处的血流量。结果 M组和H组疼痛消失时间更快;与麻醉前相比,麻醉后30 min三组患者动静脉内径及桡动脉血流量均明显增加,且M组和H组较L组增加更加明显,差异有统计学意义(P<0.05); M组和H组术后3 h、7 d、8 w时造瘘口处的血流量均高于L组,差异有统计学意义(P<0.05),但M组和H组之间未见明显区别。结论采用0.375%浓度的罗哌卡因75 mg行腋路臂丛神经阻滞可满足动静脉人工内瘘成形术手术要求并能够明显增加术后动静脉瘘口的血流量。Objective To investigate the influence of ropivacaine on the blood flow of artificial arteriovenous fistula during axillary brachial plexus block using a fixed dose but different concentrations.Methods Ninety patients with end-stage renal disease requiring manual arteriovenous fistula creation were randomly divided into three groups,using ropivacaine with 0.25%(L group),0.375%(M group),and 0.5%(H group)concentrations separately at the dose of 75 mg.The brachial plexus block was guided by ultrasound,and the pain disappearance time and pain recovery time were recorded.The diameter of the radial artery and cephalic vein and the radial artery blood flow were observed at the site of the forearm fistula before anesthesia and 30 minutes after anesthesia.The blood flow changes of the fistula at 3 rdh,7 thd,8 thw after arteriovenous fistula creation were measured.Results The M group and the H group had a faster onset of action.The diameter of radial artery and cephalic vein and radial artery blood flow increased significantly in the three groups 30 minutes after anesthesia compared with before anesthesia,and the M group and the H group increased more significantly than the L group.The blood flow at the fistula of M group and H group was higher than that in the L group at 3 rdh,7 thd,8 thw after operation,the difference was statistically significant,but there was no significant difference between the M group and the H group.Conclusions The using of ropivacaine(0.375%,75 mg) for axillary brachial plexus block could meet the requirements of arteriovenous fistula creation and can significantly increase the blood flow of arteriovenous fistula.
关 键 词:终末期肾病 罗哌卡因 腋路臂丛阻滞 动静脉人工内瘘成形术
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