地塞米松联合地佐辛在臂丛神经阻滞术后镇痛中的应用  

Clinical study of the effect of dexamethasone combined with dezocine in brachial plexus block and postoperative analgesia

作　　者：严明[1] 沈跃华[1] 周薇[1] 李祖阁 

机构地区：[1]江苏省常州市第七人民医院麻醉科,213011

出　　处：《中国医药》2014年第8期1221-1225,共5页China Medicine

摘　　要：目的 探讨地塞米松联合地佐辛用于臂丛神经阻滞术后镇痛中的效果.方法 将单侧前臂手术患者60例完全随机分为试验组和对照组,各30例.对照组应用1％盐酸利多卡因＋0.25％罗哌卡因（25 ml）,试验组应用地塞米松10 mg＋地佐辛0.1 mg/kg＋ 1％盐酸利多卡因＋0.25％罗哌卡因（25 ml）,肌间沟法行臂丛神经阻滞.麻醉前和麻醉后5、10 min记录2组患者平均动脉压、心率、呼吸频率和脉搏血氧饱和度.观察2组麻醉起效时间、阻滞完善时间、麻醉维持时间.以视觉模拟评分（VAS）评价术后镇痛效果,记录术后镇痛药使用及不良反应发生情况.结果 2组患者麻醉前和麻醉后平均动脉压、心率、呼吸频率和脉搏血氧饱和度比较差异无统计学意义（P＞0.05）.试验组麻醉起效时间、阻滞完善时间分别为（2.8±2.3）、（8.2 ±2.0）min,与对照组[（4.2±2.7）、（15.3±2.6） min]比较差异均有统计学意义（均P＜0.05）;试验组麻醉维持时间为（560±121）min,明显长于对照组[（251±110）min] （P ＜0.05）;试验组术后12、24、36、48 h VAS评分分别为（3.1±1.2）分、（3.2±1.1）分、（2.2±1.4）分、（2.0±1.2）分,与对照组[（7.2±1.6）分、（6.5±1.3）分、（5.8±1.3）分、（4.9±1.2）分]比较差异均有统计学意义（均P ＜0.05）;术后镇痛药使用率试验组（10.0％,3/30）明显低于对照组（86.7％,26/30） （P ＜0.05）;2组均未出现明显的不良反应,2组恶心、呕吐和嗜睡发生率差异无统计学意义（P＞0.05）.结论 地塞米松复合地佐辛能明显增强臂丛神经的镇痛效果,且无明显不良反应.Objective To observe the effect of dexamethasone combined with dezocine in brachial plexus block and postoperative analgesia.Methods Sixty patients undergoing brachial plexus block were randomly divided into two groups：control group （30 cases） and test group （30 cases）.Control group received 1% lidocaine ＋ 0.25% ropivacaine （25 nl）; test group received dexamethasone 10 mg ＋ dezocine 0.1 mg/kg ＋ l%lidocaine ＋ 0.25% ropivacaine （25 ml）; all patients undergoing brachial plexus block had interscalene route.Mean arterial pressure,heart rate,breathing rate and pulse oxygen saturation before and after anesthesia in two groups were recorded.The onset time of anaesthesia,the time for whole blocking and the duration of anaesthesia were observed.Postoperative analgesia was observed using visual analogue scale （VAS）.The use of analgetic and side effects in two groups were recorded.Results There were no significant differences of mean arterial pressure,heart rate,breathing rate and pulse oxygen saturation before and after anesthesia in two groups.The onset time of anaesthesia and the time for whole blocking in test group were （2.8 ± 2.3） min and （8.2 ± 2.0） min,significantly shorter than those in control group [（4.2 ± 2.7） min and （15.3 ± 2.6） min] （P 〈0.05）.The time for the duration of anaesthesia in test group was（560 ± 121） min,which was longer than that in control group （251 110） min （P 〈0.05）.The VAS scores in test group were （3.1 ± 1.2）,（3.2 ± 1.1）,（2.2 ± 1.4）,（2.0 ± 1.2） respectively at 12,24,36,48 h after operation,lower than thoses in control group [（7.2 ± 1.6）,（6.5 ± 1.3）,（5.8 ± 1.3）,（4.9 ± 1.2）] （P〈0.05）.The use of analgetic in test group was 10.0% （3/30）,which was markedly lower than that in control group （86.7%,26/30）（P 〈0.05）.The incidence rate of side effects such as nausea,vomiting and sleepiness in two groups had no differences （P 〉 0.05）.Conclusion The effect of anaesthesia

关 键 词：臂丛神经阻滞 地塞米松 地佐辛 

分 类 号：R614[医药卫生—麻醉学]