不同容量0.25%左旋布比卡因用于小儿腋路臂丛神经分支阻滞效果比较  

Effect comparison of different volumes of 0.25% evobupivacaine hydrochloride on nerve branches of axillary brachial plexus block in children

作　　者：王金保[1] 张在旺[1] 王琪[1] 杨小民[1] 

机构地区：[1]中国人民解放军白求恩国际和平医院麻醉科,河北石家庄050082

出　　处：《河北医科大学学报》2016年第2期179-182,共4页Journal of Hebei Medical University

基　　金：河北省科学技术研究与发展计划(12277735)

摘　　要：目的比较不同容量0.25%左旋布比卡因在超声引导下小儿腋路臂丛各神经分支阻滞中的效果。方法择期行手外伤手术患儿120例,ASA分级Ⅰ或Ⅱ级,随机分为0.35mL/kg组、0.30mL/kg组、0.25mL/kg组和0.20mL/kg组,每组30例,术前30min口服咪达唑仑,入室靶控输注异丙酚,待患儿睫毛反射消失和对言语指令无反应时行超声引导下腋路臂丛神经阻滞,4组患儿分别注射0.25%左旋布比卡因0.35mL/kg、0.30mL/kg、0.25mL/kg、0.20mL/kg,阻滞正中神经、肌皮神经、桡神经和尺神经,术中根据情况追加氯胺酮。观察各组神经阻滞效果、持续时间、全身麻醉药物的用量以及并发症发生情况,并评价术中麻醉效果。结果阻滞30min后4组阻滞效果和麻醉效果差异有统计学意义（P〈0.05）;0.25mL/kg、0.20mL/kg组使用氯胺酮例数多于0.35mL/kg组,0.20mL/kg组使用氯胺酮例数多于0.30 mL/kg组（P〈0.05）;0.20 mL/kg组阻滞效果持续时间短于0.35mL/kg组、0.30mL/kg组和0.25mL/kg组（P〈0.05）。结论采用0.25~0.35mL/kg剂量0.25%左旋布比卡因用于小儿上肢手术超声引导下腋路臂丛各神经分支阻滞,能够提供较满意的阻滞效果。Objective To compare the effects of different dose volume of 0.25%evobupivacaine hydrochloride on nerve branches of axillary brachial plexus block under ultrasound-guided in children.Methods A total of 120 ASA Ⅰ or Ⅱ children scheduled for surgery of the hand or forearm were randomly divided into 4groups（Groups 0.35 mL/kg,0.30mL/kg,0.25mL/kg,0.20 mL/kg）.Midazolam was administered 30 min before the operating,propofol was given by target-controlled infusion（TCI）started at entering,when the patients lost consciousnes and had no reaction to verbal instructions.Axillary road block brachial plexus was done.0.35mL/kg,0.30mL/kg,0.25mL/kg,0.20mL/kg of local anesthetics were equally injected adjacent to radial nerve, median nerve,ulnar nerve, musculocutaneous nerve respectively.Nerve block effect,duration,general anesthesia drugs dosage of each group were observated,which was used to evaluate perioperative anesthesia results.Results There was significantly difference in efficancy of nerve blocking in four groups（P〈0.05）.The cases which needed ketamine in group 0.20mL/kg were more than that in other groups.Compared to group0.35 mL/kg,0.30 mL/kg and 0.25 mL/kg,group 0.20 mL/kg showed a worse analgesia afficancy and short-time tolerance（P〈0.05）.Conclusion It provided an active amplifier by using the volume from 0.25mL/kg to 0.35mL/kg of bupivacaine for ultrasound-guided axillary approach brachial plexus block in upper limbs surgery in children.

关 键 词：神经传导阻滞 臂丛 布比卡因 

分 类 号：R614.4[医药卫生—麻醉学]